Worldwide Survey of Live Liver Donor Evaluations
Lahey Clinic, Burlington, MA
Meeting: 2013 American Transplant Congress
Abstract number: 106
Background: Evaluation protocols for living liver donors candidates (LDCs) are not standardized. We conducted a worldwide survey of LDLT programs to determine current practices for LD evaluation. Methods: Surveys were distributed via Survey MonkeyTM to programs listed with professional societies/regulatory agencies. Results: Responses were received from North America(NA,38), Europe(E,13), Asia(A,13), South America(SA,4), Middle East(1) and Australia(1). Donor evaluations per year ranged from 5-250 with 41% reporting <20 and 17% reporting > 100. Completed donations varied between >70%(11% of centers) and <30%(36% of centers). 62% used CT for volume and vasculature; 52% usesd MR for biliary imaging. Intra-op cholangiogram was used in 43 centers(61%). Cardiac testing was used in all LDCs by 58% of centers with others utilizing age or event criteria. 74% initiate cardiac testing between 40 and 50 years (stress echos most common exam). Pulmonary testing is routinely ordered by 44%. Routine coag tets(INR, PTT ± Factors V/II)are used by 96%. Proteins C, S, and antithrombin are used by 30 programs (43%). Routine liver biopsies are used by 12 centers(17%) while others biopsy for BMI(47%), liver fat on CT/MR(64%), LFTs(64%), familial autoimmunity(23%), or H/O substance abuse(20%). Absolute disqualifications are listed in Table 1.
| R/O | # centers | % | R/O | # | % |
| non-skin Ca | 58 | 83 | ABO incom | 46 | 66 |
| COPD | 56 | 80 | Bx=portal inflam | 57 | 81 |
| Active smoker | 24 | 43 | HCVAb+ | 57 | 81 |
| Suicide attempt | 54 | 77 | H/O Coag Dz | 59 | 84 |
| Psych in-pt | 55 | 79 | FacV/II abn | 38 | 54 |
| >2 psych meds | 51 | 73 | DM1 | 50 | 71 |
| No Insurance | 17 | 24 | DM 2 | 32 | 46 |
| Age >60 | 47 | 67 | Cardiac Hx | 62 | 89 |
Factors that varied by location or program experience are listed in Table 2.
| RO | Experience | Location | Comment |
| HBcAb | NS | .04 | 70% NA won't use |
| HCV Ab | NS | .008 | E,A will use |
| DM 1 | NS | .02 | E,A will use |
| Suicide attempt | .009 | NS | Exp* will use |
| No insurance | NS | .05 | NA only |
| COPD | .02 | NS | 1/2 Exp will use |
| Active smoker | .04 | .01 | Exp+E,A,SA will use |
| H/O Skin Ca | NS | .03 | A unlkely to use |
| BMI | .NA | .01 | NA higher |
| Recip FHF | .04 | NS | Exp will use |
| Recip MELD>25 | .004 | .03 | Exp will use,1/2 NA won't |
Conclusions: 1.Regional and cultual differences have significant impact on acceptability of certain LDCs. 2.Experienced centers are more willing to perform LDLT in sick recipients or use donors with certain non-transmissible conditions. 3.Fewer than 50% of candidates complete donation. 4.Cardiac and pulmonary testing performed on all candidates by 58% and 44% of centers, respectively; but only 17% do liver biopsies on all donors.
To cite this abstract in AMA style:
Simpson M, Cheah Y, Pomposelli J, Pomfret E. Worldwide Survey of Live Liver Donor Evaluations [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/worldwide-survey-of-live-liver-donor-evaluations/. Accessed November 22, 2024.« Back to 2013 American Transplant Congress