[10 Years of Experience in Living Donation for Liver Transplantation in Pediatric Patients - A Single Centre Study]

Living donor liver transplantation poses new issues related to the performance of a major surgery on a healthy person - the living donor. Thus, it requires precise logistics to ensure positive outcome for both the donor and the recipient, outweighing the risks associated with donation and transplantation. For this purpose, we developed an original three phase protocol for evaluation of candidate donors with set of mandatory assays. This paper aims to analyze the outcomes of this protocol. 89 candidates have been examined for the performance of 23 living donor liver transplantations. The procedure was successfully completed by 25 candidates (28.1%), including two cases of procedure suspension due to occurrence of a suitable deceased donor. The majority of exclusions occurred in the third phase, generally due to anatomical variations: arterial (17%), portal (9.68%), venous (18.15%) and biliary (18.15%), and for several reasons simultaneously (6.7%). NO exclusions occurred due to inadequate potential graft or residual volume. All living donors underwent left lateral resection and the measured volumes were enough for both the recipients and the donors. No significant complications occurred in the donors (Clavien 1: 21%, Clavien II: 4%), with no need of transfusion, reoperation or re-hospitalization. The laboratory parameters were restored to normal values within the 10th postoperative day as the average hospital stay was 14.7 days. All donors were discharged with normal laboratory, instrumental and physical parameters. No abnormalities were observed at long-term follow-up. No primary graft dysfunction was observed. The large proportion of declined candidates requires strict adherence to the precise sequence of the evaluation protocol. The main reasons for decline are anatomical variation. Los level of complicatons was registered, with short postoperative stay, normal laboratory results at discharge and normal physiological parameters at long-term follow-up. The concept of donor advocate was introduced for the first time in Bulgaria. His task is to defend the interests of the candidate donor and to provide assistance in making an informed decision.