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Living donor liver transplants are increasingly emerging to increase the number of transplant patients and reduce the demand for deceased donor transplants.
Living liver transplantation (LDLT) from direct and non-direct living donors continues to expand the pool of organ donors in the United States, reducing surgical wait times and improving Model for End-Stage Liver Disease (MELD) scores at the time of transplantation. It's going down, and your score is going down. According to a review article, the number of deaths on the waiting list liver transplant.
“LDLT is an important surgical technique that increases the chances of survival-prolonging transplant surgery,” said the lead author. Dr. Kiran Bambawrites a colleague.
“While LDLT has expanded in the United States over the past several years, we have significant opportunities for further advancement. and new initiatives that are summarized in this review,” said Dr. Bamba. Doctor's weekly magazine.
The number of liver transplant operations will increase to more than 10,000 in 2023, with 94% of livers coming from deceased donors and about 20% of potential recipients dying on the waiting list. Expanding the living donor pool could improve outcomes for LDLT recipients and reduce the demand for deceased donor liver transplants.
Progress and challenges in LDLT
- LDLT requirements ethical decisions. Although LDLT provides benefits to the recipient, the mortality rate for healthy donors is approximately 0.2% and the complication rate is 30% to 40%. The need for LT must be weighed and both donor and recipient must understand the “risk-to-potential benefit” ratio.
- This procedure can extend the lifespan of the candidate. Low MELD score and Lower stages of cirrhosis People who are at risk of liver-related morbidity or mortality while on the waiting list. In one analysis of 10 years of transplant registry data, LDLT increased recipients' survival by 13 to 17 years compared with patients who remained on the waiting list.
- Grade 3 acute to chronic liver failure Although 28-day mortality can reach 100%, studies have shown that patients with this disease have a 1-year survival rate after LT of up to 80%, with higher rates in grades 1 and 2.
- For LDLT No upper age limit Candidates are becoming more available, including older donors and recipients. By 2030, approximately 20% of Americans will be 65 years of age or older, and that proportion is likely to increase with the need for LT. Healthcare providers around the world are now actively accepting older donors, and data suggest that transplants among selected older living donors and recipients may be safe. I am.
- fatty liver (HS) Common in living and deceased donors. Although the potential negative effects of excess HS (>30% to 60%, as measured by liver biopsy) on deceased donor graft livers are severe and widespread, some LT programs have shown that steatosis of up to 60% Concomitant deceased donor grafts are considered. “Many LDLT programs do not consider donors with more than mild HS, as HS above a certain severity can potentially jeopardize donor safety, especially in the case of right lobe donation. “No,” the authors write.
- transplant oncology In recent years, the number of patients with primary and metastatic malignancies, including advanced hepatocellular carcinoma exceeding the Milan criteria, locally advanced intrahepatic bile duct cancer, and patients with unresectable colorectal cancer liver metastases, is increasing. patients are living longer. Causes of cancer-related deaths worldwide.
Advantages of LDLT compared to deceased donor liver transplantation in transplant oncology include shorter waiting times, careful assessment of tumor treatment response before transplantation, reduced risk of tumor progression, and surgical schedule compatible with preoperative chemotherapy. Included.
Main purpose of 2nd stage LD-RAPID porting Oncology procedures reduce risk to the donor but may increase risk to the recipient.
- Non-directive living liver donation It usually involves an anonymous healthy person voluntarily donating part of their liver to another person.
- Liver pair replacement Occurs between incompatible donor and recipient pairs, usually due to blood type or anatomical mismatch. This procedure may involve a simple two-way exchange or a living donor chain with multiple donor-recipient pairs.
- domino liver transplant It involves a liver transplant from one person with a metabolic disease to another with end-stage liver disease. Domino donors receive either the liver of a deceased donor or part of the liver of a living donor.
Innovative training required
LDLT programs at transplant centers across the United States are expanding, increasing the need to prioritize the training of current and future transplant surgery staff.
“LDLT offers transplants to more patients and provides the liver transplant community with an opportunity to innovate how we can best serve more patients in the future,” says Dr. Bamba.
