Evaluation of 100 patients for living donor liver transplantation

The initial success of living donor liver transplantation (LDLT) in the Uni ted States has resulted in a growing interest in this procedure. The impact of LDLT on liver transplantation will depend in part on the proportion of patients considered medically suitable for LDLT and the identification of s uitable donors. We report the outcome of our evaluation of the first 100 po tential transplant recipients for LDLT at the University of Colorado Health Sciences Center (Denver, CO),AU patients considered for LDLT had first bee n approved for conventional liver transplantation by the Liver Transplant S election Committee and met the listing criteria of United Network for Organ Sharing status 1, 2A, or 2B, Once listed, those patients deemed suitable f or LDLT were given the option to consider LDLT and approach potential donor s. Donors were evaluated with a preliminary screening questionnaire, follow ed by formal evaluation. Of the 100 potential transplant recipients evaluat ed, 51 were initially rejected based on recipient characteristics that incl uded imminent cadaveric transplantation (8 patients), refusal of evaluation (4 patients), lack of financial approval (6 patients), and medical, psycho social, or surgical problems (33 patients). Of the remaining 49 patients, c onsidered ideal candidates for LDLT, 24 patients were unable to identify a suitable donor for evaluation. Twenty-six donors were evaluated for the rem aining 25 potential transplant recipients. Eleven donors were rejected: 9 d onors for medical reasons and 2 donors who refused donation after being med ically approved. The remaining 15 donor-recipient pairs underwent LDLT. Usi ng our criteria for the selection of recipients and donors for LDLT gave th e following results: (1) 51 of 100 potential transplant recipients (51%) we re rejected for recipient issues, (2) only 15 of the remaining 49 potential transplant recipients (30%) were able to identify an acceptable donor, and (3) 15 of 100 potential living donor transplant recipients (15%) were able to identify a suitable donor and undergo LDLT. Recipient characteristics a nd donor availability may limit the widespread use of LDLT. However, carefu l application of LDLT to patients at greatest risk for dying on the waiting list may significantly reduce waiting list mortality.