What can we learn from living donor evaluation? A higher prevalence of metabolic diseases and less technical contraindication

Abstract

Introduction: This study aimed to identify acceptance rate and outcomes of living liver donor evaluation. Methods: This was a retrospective study, data from all living liver donor candidates and their respective recipients were analyzed. Results: From 1996 to 2017, 1,138 liver transplant (LT) candidates with 1,780 potential living donors were evaluated in Queen Mary Hospital, Hong Kong. A total of 798/1,780 (44.8%) potential donors were accepted for liver donation and eventually 587/798 (73.6%) underwent living donor liver transplantation (LDLT). Majority (65.3%) of recipients only had one potential donor. Majority of potential donors were rejected due to various medical conditions (390/926; 42.1%) followed by ABO incompatibility (217/926; 23.4%). The most common medical condition that led to rejection has changed from hepatitis B/C carrier status to metabolic syndrome in recent decade. Incidental malignancy was identified in 8 potential donors during evaluation. Another common reason for non-acceptance was donor withdrawal (n=252) and psychiatric condition (n=17). Technical contraindication eg vascular (n=6) and biliary (n=1) anatomy rarely led to donor rejection. There was also a change in donor/recipient relationship. Over 60% of liver donors were biologically related to recipients but the ratio in siblings as potential donor has dropped significantly (18.9% to 12.4%) and there was a marked increase in Good Samaritan donors/friends as liver donor (5.2% to 18.3%). Conclusions: Overall donor acceptance rate was 44.8%. With technical advancement and experience in LDLT, technical reason rarely led to donor rejection. Donor metabolic syndrome is the most common reason for donor rejection and has increased significantly in recent decade.