Living-donor liver transplantation: evaluation of donor and recipient

Living-donor liver transplantation (LDLT) in adults has been expanded after becoming the standard for children in many transplant centres. Advantages of LDLT include thorough donor screening, optimization of timing for transplantation and minimal cold ischaemia time. However, the risk of donor morbidity and mortality must be considered. The preoperative evaluation of the donor typically is performed in consecutive stages. Specific donor considerations in LDLT are thrombosis and embolism, hepatic mass and hepatic steatosis. After complete evaluation, only a small proportion of potential donors are satisfactory candidates. The evaluation protocol for LDLT recipients in most centres is not different from that of cadaveric transplantation. More experience and the development of specific selection and evaluation criteria will further increase the benefit for the recipient and decrease the risk of the donor.