Background and Aims: Organ shortage has been the ongoing obstacle to expand liver transplantation world-wide. Living donor liver transplantation (LDLT) was hoped to improve this shortage. The aim of the present study was to analyse the impact of metabolic syndrome and prevalent liver disease on living donations. Methods: From July 2007 to December 2012, a total of 171 deceased donor liver transplants and 190 living donor liver transplants (LDLT) were performed at our institution. In total, 265 patient were excluded because of either diabetes or a body mass index (BMI) >28. Eight hundred potential living donors were assessed according to a step-wise evaluation protocol. The age of the donors receiving work-up ranged from 18 to 60 years. The majority were first and second degree relatives of the patients. Results: Only 190 (24%) were accepted for donation and 610 (76%) were rejected. Some potential donors were excluded at initial screening due to incompatible blood groups (115; 14.3%), social reasons (40; 5%), or elevated liver enzymes (9; 1%). A total of 85 (10.5%) donors were excluded due to positive hepatitis serology. Steatosis resulted in the exclusion of 84 (10.5%) donors. In addition, 80 (10%) potential donors were rejected due to variations in biliary anatomy, and 20 (2%) were rejected due to aberrant vascular anatomy. Rejection due to biliary-related aberrancy decreased significantly in the second half of our program (14.5% vs. 5%, p=0.0001). In total, 110 (13.7%) potential donors were rejected due to insufficient remnant volume (<30%) as determined by CT volumetry, whereas 24 (3%) were rejected due to a graft-to-recipient body weight ratio less than 0.8%.Conclusion: metabolic syndrome and viral hepatitis negatively impacted our living donor pool. Expanding the donor pool requires the implementation of new strategies.

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