Yale School of Medicine and Yale New Haven Transplant Center, New Haven, Connecticut, USA.
Transplant Institute, Henry Ford Health System, Detroit, Michigan, USA.
Clin Transplant. 2023 Jul;37(7):e14953. doi: 10.1111/ctr.14953. Epub 2023 Mar 20.
Living donor liver transplantation (LDLT) reduces liver transplant waitlist mortality and provides excellent long-term outcomes for persons with end stage liver disease. Yet, utilization of LDLT has been limited in the United States (US).
In October 2021, the American Society of Transplantation held a consensus conference to identify important barriers to broader expansion of LDLT in the US, including data gaps, and make recommendations for impactful and feasible mitigation strategies to overcome these barriers. Domains addressed encompassed the entirety of the LDLT process. Representation from international centers and living donor kidney transplantation were included for their perspective/experience in addition to members across disciplines within the US liver transplantation community. A modified Delphi approach was employed as the consensus methodology.
The predominant theme permeating discussion and polling results centered on culture; the beliefs and behaviors of a group of people perpetuated over time.
Creating a culture of support for LDLT in the US is key for expansion and includes engagement and education of stakeholders across the spectrum of the process of LDLT. A shift from awareness of LDLT to acknowledgement of benefit of LDLT is the primary goal. Propagation of the maxim "LDLT is the best option" is pivotal.
活体供肝肝移植（LDLT）降低了肝移植候补者的死亡率，并为终末期肝病患者提供了极好的长期预后。然而，LDLT 的应用在美国受到限制。
2021 年 10 月，美国移植学会召开了一次共识会议，以确定在美国更广泛推广 LDLT 的重要障碍，包括数据差距，并提出有影响力和可行的缓解策略建议，以克服这些障碍。所涉及的领域涵盖了 LDLT 过程的全部内容。国际中心和活体供肾移植的代表也应邀参加了会议，除了来自美国肝移植界各学科的成员外，他们还从自己的角度/经验出发提出了意见。采用改良 Delphi 方法作为共识方法。
贯穿讨论和投票结果的主要主题是文化；一个群体的信仰和行为随着时间的推移而延续。
在美国营造支持 LDLT 的文化对于扩大 LDLT 的应用至关重要，包括在 LDLT 过程的各个方面与利益相关者的参与和教育。从对 LDLT 的认识转变为对 LDLT 的益处的承认是主要目标。传播“LDLT 是最佳选择”的理念至关重要。
