Adult-to-adult living donor liver transplantation in a low-middle income country setting: eight-year experience from...

Living donor liver transplantation is a vital option in low- and middle-income countries with limited access to deceased donor organs. In 2017, Fundación Cardioinfantil-La Cardio established Colombia's first adult living donor liver transplantation program. This study describes donor selection, outcomes, and complication proportion over eight years.

We conducted a retrospective cohort study of all adult donor candidates evaluated between February 2017 and January 2025. Donors underwent a comprehensive four-phase assessment (clinical, laboratory, psychosocial, and imaging). Eligibility criteria included age 18-50, BMI <30 kg/m² or minimal hepatic steatosis, ABO compatibility, residual liver volume >35%, and graft-to-recipient weight ratio >1% (or >0.8% for donors under 35). Graft volume estimates were validated intraoperatively using CT-based volumetry. Postoperative complications were classified using Clavien-Dindo, and bivariate analyses explored predictors of adverse outcomes and hospital stay duration.

Of 137 candidates, 133 were included, and 63 (47.4%) completed donation. Donors had a mean age of 31.4 years, and 51.9% were women. Main exclusion reasons included steatosis >20%, recipient receiving a deceased donor organ, anatomical variants, and low graft volume. Among donors, 81.1% experienced no complications. Minor complications (12.7%) included biliary issues, liver dysfunction, and surgical site infections. No vascular or thrombotic events were reported. Elevated ICU liver enzymes were associated with complications and prolonged hospitalization. A learning curve was evident, with fewer severe complications observed after the 44th procedure.

These findings demonstrate the feasibility and safety of living donor liver transplantation in resource-constrained settings, supporting the development of similar programs in LMICs.