Kupke, Paul and Schropp, Verena and Schurr, Leonhard A. and Dropco, Ivor and Kupke, Laura S. and Goetz, Markus and Geissler, Edward K. and Schlitt, Hans J. and Werner, Jens M. (2025) Optimization of surgical evaluation algorithms for living donor liver transplantation. DIGESTIVE AND LIVER DISEASE, 57 (3). pp. 724-729. ISSN 1590-8658, 1878-3562
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Background: Living donor liver transplantation (LDLT) is an established and endorsed alternative for deceased donor liver transplantation with better recipient outcomes. Nevertheless, while extensive evaluation of potential donors is crucial, evaluation algorithms differ between transplant centres and guidelines. Methods: We included 317 individuals evaluated for LDLT between 07/2007-07/2022 in a retrospective analysis. The evaluation process was analysed to identify the key reasons for declining 77 potential donors. Additionally, 146 donors that underwent LDLT were analysed regarding risk factors for complications. Results: The main reasons for donor refusal were liver volumetry (40.3 %) and metabolic factors including obesity or steatotic liver disease (20.8 %). Contrast-enhanced computed tomography (CECT) identified 63.6 % of all declined donors; CECT combined with assessment of medical history, physical examination, blood testing and ultrasonography, identified 87.0 % of declined potential donors. Associated with this selection, complication rates in donors were low ( >= II in 17.1 %; none with >= IVb). Notably, higher age was a risk factor for developing a complication >= II after hemi-hepatectomy ( p = 0.0373). Conclusions: We propose a progressive 4-step evaluation algorithm that begins with a very basic assessment combined with up-front CECT. This early phase of testing is expected to identify nearly 90 % of ineligible donors, thereby conserving critical resources, time and money, as well as minimising burden for potential donors. Funding: J.M.W. received funding by grant We-4675/6-1 from the Deutsche Forschungsgemeinschaft (DFG) in Bonn, Germany . (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Complications; Evaluation algorithm; Living donor liver transplantation; Liver volumetry; Outcomes; Steatotic liver disease |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Chirurgie Medicine > Lehrstuhl für Röntgendiagnostik |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 29 Sep 2026 06:46 |
| Last Modified: | 29 Sep 2026 06:46 |
| URI: | https://pred.uni-regensburg.de/id/eprint/66061 |
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