Living Donor Liver Transplantation (LDLT)

Liver transplant (LT) has become the standard of care of end-stage liver disease (ESLD) or unresectable hepatocellular carcinoma. There are at least 18,000 patients on the wait list for a deceased donor liver donation. However, there is a critical shortage of donor organs, contributing to increasing wait-list mortality as well as profound acuity of patients when organs do become available. Living donor liver transplantation (LDLT) has become widely accepted in United States (US) as a potential alternative source of organs for patients eligible for liver transplantation. Several important factors have limited the significant growth of LDLT. LDLT is a technically challenging procedure that requires significant training and institutional and programmatic commitment and support. Furthermore, there are risks associated with donor procedure including potential liver failure and death, which call the ethics of LDLT into question. For these reasons and since LDLT is relatively new procedure, there are a few major transplant centers in the US performing this procedure. The National Institute of Health organized a network of nine leading transplant centers establishing the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) to study outcomes for LDLT in the US in 2002. The study was dedicated to reporting and investigating short and long-term outcomes for both recipients and donors. As the funding cycle concludes in 2015, the observations and publications of the consortium have contributed tremendously to the North American development of LDLT as an option for patients with ESLD and complications requiring transplantation.