J Xiao et al. Liver Transplantation 2024; 30: 493-504 The incidence of adverse outcome in donors after living donor liver transplantation: A meta-analysis of 60,829 donors

This meta-analysis consisted of eighty-seven articles involving 60,829 living liver donors.

Key findings:

• The overall pooled incidence of complications in LDLT donors was 24.7%
• The incidence of minor complications was 17.3%
• The incidence of major complications was 5.5%
• The overall incidence of donor mortality was 0.06% in 49,027 individuals**. 
• Psychological complications 7.6% were the most common complications among LDLT donors. This was followed by wound-related complications 5.2%
• Table 2 (below) gives an extensive list of potential complications and their incidences in this cohort

**In the discussion, the authors note that “donor mortality is a devastating outcome in LDLT…Our study found that Asian countries reported a lower rate…For example, in Japan, the rate of donor mortality was 0.3 deaths per 1000 donors, while in the United States and Europe, donor mortality rates were 1.7 and 2.3 deaths per 1000 donors, respectively. While this observation may be attributed to greater experience in LDLT in Asian centers, it is also possible that underreporting in Asian centers might play a role. Mortality in donors…may result in the suspension or termination of an LDLT program.”

My take: Even with potential underreporting, this study highlights the very real risks associated with trying to save a life via LDLT.

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• Improved Outcomes with Living Donor Livers for Vulnerable Recipients
• First-Hand Account: Living-Donor Liver Transplantation