Future of adult living donor liver transplantation

Key Points 1. Future application of adult living donor liver transplantation (ALDLT) will be determined by accurate assessment of hazards imposed on the donor and documentation of potential benefits for the recipient. 2. Definition of the risks imposed on living donors can be elucidated only by the adoption of a standardized uniform method for adverse-event reporting that defines the severity of complications and assessment of living donor health-related quality of life after donation. 3. Recipient survival outcomes after ALDLT should be risk adjusted to allow valid comparison to outcomes achieved by whole-organ transplantation. 4. Short-and long-term transplant recipient complications must be compared with those of whole-organ recipients by using standardized approaches. 5. The use of living donor grafts in patients with hepatitis C virus (HCV) infection and hepatocellular carcinoma (HCC) must be investigated because advantages of early transplantation in HCV-infected transplant recipients may be offset by risks for graft loss caused by rapid recurrence, whereas early transplantation of patients for HCC may not provide additional survival benefits because shorter waiting times may negate evaluation of tumor biological characteristics, as is possible by longer waiting times for cadaveric transplant recipients.