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First Experience in Living Liver Donation From Donors With Sickle Cell Trait

Maren Schulze1, Ahmed Zidan1, Mark Sturdevant2

  • 1Department of Abdominal Transplant and Hepatobiliary Surgery, Organ Transplant Centre of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Transplantation Direct
|May 13, 2022
PubMed

Insights

Living donor liver transplantation in sickle cell trait (SCT) carriers is safe and effective. This study shows no SCT-related complications in donors, with excellent graft and recipient survival rates.

Area of Science:

  • Transplantation Surgery
  • Hematology
  • Organ Donation

Background:

  • Living donor liver transplantation (LDLT) is crucial in the Middle East, necessitating donor safety protocols.
  • High incidence of sickle cell trait (SCT) in the region requires careful donor selection criteria.
  • Prior surgical experience with SCT patients informed the decision to evaluate SCT carriers as potential living liver donors.

Purpose of the Study:

  • To assess the safety and outcomes of accepting living donors with sickle cell trait (SCT) for liver transplantation.
  • To evaluate donor and recipient complications and survival rates in LDLT involving SCT donors.
  • To establish a precedent for considering SCT carriers as living liver donors on an exceptional basis.

Main Methods:

  • A retrospective review of 20 living donors with SCT undergoing liver donation between January 2012 and September 2021.
  • Analysis included donor demographics, hemoglobin S (HbS) levels, surgical approach, and perioperative outcomes.
  • Management of HbS levels (phlebotomy or exchange transfusion) and follow-up for donor/recipient complications and survival were recorded.

Main Results:

  • Twenty SCT donors (average age 28.4 years) donated liver segments (left lateral or left lobe) to related recipients.
  • HbS levels ranged from 21.2% to 39.9%, with 14 donors having ≥30% HbS, managed effectively.
  • Surgical outcomes, including OR time, blood loss, and ICU stay, were comparable to non-SCT donors, with no SCT-related complications and 100% graft/recipient survival.

Conclusions:

  • Living donor liver transplantation with sickle cell trait carriers is feasible and safe.
  • This single-center experience demonstrates excellent outcomes, supporting the acceptance of SCT donors under specific criteria.
  • Encourages other high-SCT prevalence countries to report similar experiences to expand donor pools.

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