Staged preoperative evaluation of potential living donors for liver transplantation

Living donor selection is crucial to minimize postoperative donor complications and to improve recipient outcomes. This study describes the selection process and evaluates the reasons for discarding potential donors in our living donor liver transplantation (LDLT) program.

Retrospective descriptive analysis from all potential donors evaluated in our LDLT program between April 2018 and July 2021. Selection criteria included age 18-60 years old, no significant medical or mental comorbidities, ABO and anatomical suitability.

A total of 231 potential donors were evaluated. Mean age was 37.2±11.1 years and male gender in 51.9%. One hundred and one potential donors (43.7%) did not complete the evaluation, mainly because of availability of a deceased donor during the process (n=32; 13.9%), ABO incompatibility (n=14; 6.1%), progression or death of the recipient (n=20; 8.7%). Of the 130 who completed their radiological evaluation, 55 (42.3%) were anatomically unsuitable, mainly due to small liver remnant size (n=25/130; 19.2%) and steatosis (n=17/130; 13.1%). Out of the 231 potential donors, 75 were accepted as adequate donors (32.5%) and 36 candidates underwent liver donation (15.6%).

Only one-third of all potential donors are suitable for donation and half of them will undergo surgery. Given that in our setting computed tomography (CT) has a lower cost than magnetic resonance imaging (MRI), starting with a CT scan decreases the high cost of further workup of donors that are not anatomically suitable for living liver donation.