Applicability of living donor liver transplantation to high-urgency patients

Background. Cadaveric liver donors are scarce in Hong Kong, and the applica tion of liver transplantation to high-urgency patients is limited. We evalu ated the use of grafts from living donors in this setting, Methods. From July 1994 to January 1998, 49 consecutive adult patients who were intensive care unit-bound because of acute or chronic liver failure we re put on a high-urgency list for liver transplantation. Family members wer e not solicited for living donation, and the initiation and decision for li ving donor liver transplantation (LDLT) was based on the donor's voluntary intent, Assessment of the living donor, including blood tests, computed tom ographic volumetry, and angiography, was performed only after informed cons ent was executed. Results. In 25 of 49 (51%) patients, no family member volunteered as living donor; 23 died awaiting donor organs, and 2 received a cadaveric graft, Tw enty-four (49%) patients had 36 family members who volunteered as living do nors, Before evaluation of living donor was completed, two patients receive d a cadaveric liver transplant, LDLT was not performed in nine patients bec ause of recipient contraindications (n=4), ABO blood group incompatibility (n=3), and withdrawal of donor (n=2). Eight of these nine patients died, an d one received a cadaveric liver graft, The remaining 13 (27%) patients rec eived grafts from living donors, Four of 5 (80%) patients who underwent cad averic liver transplantation and 11 of 13 (85%) who underwent LDLT survived . Thus, emergency transplantation from living donors increased the applicab ility of liver transplantation from 10% to 37%, and the survival rate after emergency LDLT (85%) was superior to that of the remaining patients (11%), Conclusions. When cadaveric organ donation is scarce, emergency liver trans plantation from living donors can be applied to high-urgency adult patients .