Sotomayor Camila, García Daniel, Rebolledo Patricia, Dominguez Maria Pilar, Pastoré Antonia, Achurra Pablo, Viñuela Eduardo, Arab Juan Pablo, Benitez Carlos, Huete Alvaro, Briceño Eduardo, Martinez Jorge, Jarufe Nicolas, Dib Martin J
Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Transl Gastroenterol Hepatol. 2025 Jan 17;10:2. doi: 10.21037/tgh-24-65. eCollection 2025.
Living donor selection is crucial to minimize postoperative donor complications and to improve recipient outcomes. This study describes the selection process and evaluates the reasons for discarding potential donors in our living donor liver transplantation (LDLT) program.
Retrospective descriptive analysis from all potential donors evaluated in our LDLT program between April 2018 and July 2021. Selection criteria included age 18-60 years old, no significant medical or mental comorbidities, ABO and anatomical suitability.
A total of 231 potential donors were evaluated. Mean age was 37.2±11.1 years and male gender in 51.9%. One hundred and one potential donors (43.7%) did not complete the evaluation, mainly because of availability of a deceased donor during the process (n=32; 13.9%), ABO incompatibility (n=14; 6.1%), progression or death of the recipient (n=20; 8.7%). Of the 130 who completed their radiological evaluation, 55 (42.3%) were anatomically unsuitable, mainly due to small liver remnant size (n=25/130; 19.2%) and steatosis (n=17/130; 13.1%). Out of the 231 potential donors, 75 were accepted as adequate donors (32.5%) and 36 candidates underwent liver donation (15.6%).
Only one-third of all potential donors are suitable for donation and half of them will undergo surgery. Given that in our setting computed tomography (CT) has a lower cost than magnetic resonance imaging (MRI), starting with a CT scan decreases the high cost of further workup of donors that are not anatomically suitable for living liver donation.
活体供体的选择对于将术后供体并发症降至最低并改善受体预后至关重要。本研究描述了选择过程，并评估了在我们的活体肝移植（LDLT）项目中舍弃潜在供体的原因。
对2018年4月至2021年7月期间在我们的LDLT项目中评估的所有潜在供体进行回顾性描述性分析。选择标准包括年龄在18至60岁之间，无重大医学或精神合并症，ABO血型和解剖学适宜性。
共评估了231名潜在供体。平均年龄为37.2±11.1岁，男性占51.9%。101名潜在供体（43.7%）未完成评估，主要原因是在此过程中出现了脑死亡供体（n=32；13.9%）、ABO血型不相容（n=14；6.1%）、受体病情进展或死亡（n=20；8.7%）。在完成放射学评估的130名供体中，55名（42.3%）解剖学上不合适，主要原因是肝残余体积小（n=25/130；19.2%）和脂肪变性（n=17/130；13.1%）。在231名潜在供体中，75名被接受为合适供体（32.5%），36名候选者进行了肝脏捐赠（15.6%）。
所有潜在供体中只有三分之一适合捐赠，其中一半将接受手术。鉴于在我们的机构中，计算机断层扫描（CT）的成本低于磁共振成像（MRI），从CT扫描开始可降低对解剖学上不适合活体肝移植的供体进行进一步检查的高昂成本。
