Current status and perspectives of living donor liver transplantation

Living donor liver transplantation (LDLT) has been an established treatment modality for patients with end stage liver diseases. especially in countries with scarcity of deceased donors. The annual number of LDLT cases in Korea has been steeply increasing, exceeding that of Japan and even doubling that of United States in 2007. When comparing LDLT and deceased donor liver transplantation (DDLT). the timely availability and quality of liver grafts are superior in LDLT, but there are definite drawbacks from anatomical sharing of 1 liver organ by 2 individuals as well as potential donor risk. Biliary complications seem to be the most intractable problems following adult LDLT. The indications for LDLT are nearly identical to those of DDLT. The optimal timing for performing LDLT is not clearly defined, but an earlier transplantation is often recommended before serious worsening of general conditions. The post-transplant management following LDLT is often more difficult than that of DDLT although early liver regeneration makes the liver graft large enough. Current situation in Korea requires a heavy demand on DDLT, but it is still very difficult to expect a rapid rise of deceased donor number within a few years. Thus, LDLT may continue to play the pivotal role to compensate for the serious shortage of deceased donor organs. Coercion to living donors should be prohibited in any situation. The medical team and our whole society should pay special attention to caring of living donors in order to encourage organ donation.