Living donor liver transplantation in South Africa: the donor experience

Abstract

Background: Living donor liver transplantation (LDLT) plays a crucial role in liver transplant programmes, particularly in regions with a scarcity of  deceased donor organs and especially for paediatric recipients. LDLT is a complex and demanding procedure which places a healthy living donor in  harm’s way. Donor safety is therefore the overriding concern. This study aimed to report our standardised approach to the evaluation, technical aspects  and outcomes of LDLT donor hepatectomy at Wits Donald Gordon Medical Centre.

Methods: The study population consisted of all patients undergoing  LDLT donor hepatectomy since the inception of the programme in March 2013 until  2018. Sixty five living donor hepatectomies were performed. Primary outcome measures included donor demographics, operative time, peak bilirubin,  aspartate and alanine transaminase levels postoperatively, length of hospital stay and postoperative complications using the Clavien-Dindo classification. 

Results: The majority of the donors were female, most were parents with mothers being the donor almost 85% of the time. The median operative time  was 374 minutes with a downward trend over time as experience was gained. The median length of hospital stay was 7 days. There was no mortality and  the complication rate was 30% with the majority being minor (Grade 1).

Conclusion: Living donor liver transplant from adult-to-child has been successfully  initiated in South Africa. Living donor hepatectomy can be safely performed with acceptable outcomes for the donor. Wait-list mortality  however remains unacceptably high. Expansion of LDLT as well as real change in deceased donor policy is required to address this issue.