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Updated: Aug 22, 2025
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Marginal parental donors for pediatric living donor liver transplantation
Mureo Kasahara1, Seisuke Sakamoto1, Akinari Fukuda1
1National Center for Child Health and Development, Tokyo, Japan.
Insights
Careful selection of living donors is crucial for pediatric liver transplantation (LT) success. Identifying marginal donors with potential risks prevents complications in both the living donor and the recipient.
Area of Science:
- Hepatology
- Transplantation Medicine
- Pediatric Gastroenterology
Background:
- Living donor liver transplantation (LT) is an effective treatment for various liver diseases, including cholestatic and metabolic conditions.
- Indications for LT have expanded, highlighting the importance of living donor selection, especially for pediatric inherited diseases.
- Preventing morbidity in both living donors and recipients is paramount in pediatric LT.
Approach:
- Review of 30 years of pediatric living donor LT experience in Japan.
- Identification of specific risk factors in parental living donors.
- Emphasis on meticulous donor evaluation protocols.
Key Points:
- Marginal parental living donors may present risks, including heterozygous deficiencies (ornithine transcarbamylase, protein C, hypercholesterolemia), asymptomatic intrahepatic bile duct paucity, and HLA-homozygous donors.
- These situations, though infrequent, necessitate thorough evaluation to optimize pediatric recipient outcomes.
- Avoiding additional hazards in living donors is critical, as the procedure itself carries inherent risks for healthy individuals.
Conclusions:
- Meticulous evaluation of living donors is essential for successful pediatric liver transplantation.
- Identifying and mitigating risks associated with marginal donors improves outcomes.
- Careful donor selection ensures the safety of the living donor and the success of the transplantation.
Purpose Of Review:
Living donor liver transplantation (LT) has been increasingly recognized as an effective treatment modality with excellent patient survival. Indications for LT have evolved not only for cholestatic liver disease, but also metabolic liver diseases. Living donor selection, particularly for pediatric inherited disease, is essential to prevent morbidity, both in the donor and recipient.
Recent Findings:
Based on 30 years of experience in pediatric living donor LT in Japan, we could identify marginal parental living donors who have potential risks following LT, including heterozygous mothers with ornithine transcarbamylase deficiency, heterozygous protein C deficiency, heterozygous hypercholesterolemia, heterozygous protoporphyria, asymptomatic parental donors with paucity of intrahepatic bile duct, and human leukocyte antigen-homozygous parental donors.
Summary:
Although these situations seem rare due to infrequency of the condition, careful living donor evaluation is required to optimize the outcomes for pediatric recipients. In the setting of an appropriate selection of a living donor, we should avoid any additional hazards, given that the procedure itself has risks for a healthy individual.
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