Living liver donor safety: Early postoperative considerations of living liver donation guidelines from the ILTS-iLDLTG consensus conference
Living donor liver transplantation (LDLT) is a life-saving procedure for patients with end-stage liver disease. As its use expands worldwide, ensuring the safety and well-being of live liver donors (LLD) is of paramount importance. Published evidence on early postoperative complications after living donor hepatectomy-those occurring within 90 days of surgery-is limited, and standardized postoperative care protocols are lacking. The International Liver Transplantation Society (ILTS) and the International Living Donor Liver Transplantation Group (iLDLT Group) convened a consensus conference in Toronto in March 2025 to develop guidelines for the safe care of the LLDs. This manuscript details the recommendations on early postoperative considerations for the safety of LLDs developed by Working Group III (WGIII) of the Consensus Scientific Committee, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for assessment of recommendations, and the Danish model of consensus. WGIII addressed four key areas: (1) standardized postoperative care, (2) early biliary complications, (3) early postoperative liver dysfunction, and (4) early postdischarge follow-up. This report emphasizes the need for vigilant postoperative monitoring in specialized units, with access to experienced providers and defined clinical pathways. Structured clinical and psychosocial follow-up protocols, perioperative prophylaxis for surgical site infections and venous thromboembolism, and management of early biliary and vascular complications are discussed. These may help standardize care, reduce complications and improve short-term outcomes in LLDs.
Authors
- Ryan Chadha (ORCID: https://orcid.org/0000-0002-7463-6912)
- Julie K. Heimbach (ORCID: https://orcid.org/0000-0002-3567-1328)
- Marta Tejedor (ORCID: https://orcid.org/0000-0001-7563-1294)
- Akila Rajakumar (ORCID: https://orcid.org/0000-0002-3279-7881)
- John J. Fung (ORCID: https://orcid.org/0000-0002-3038-0441)
- Prashant Bhangui (ORCID: https://orcid.org/0000-0002-4839-5852)
- Ashwin Rammohan (ORCID: https://orcid.org/0000-0001-9528-8892)
- Manikandan Kathirvel (ORCID: https://orcid.org/0000-0001-8798-8856)
- Norah A. Terrault (ORCID: https://orcid.org/0000-0003-4143-1950)
- Fabrizio Di Benedetto (ORCID: https://orcid.org/0000-0002-6718-8760)
- Dieter Clemens Broering (ORCID: https://orcid.org/0000-0002-8989-1975)
- Patrizia Burra (ORCID: https://orcid.org/0000-0002-8791-191X)
- S Sudhindran (ORCID: https://orcid.org/0000-0002-9947-2678)
- Gideon M. Hirschfield (ORCID: https://orcid.org/0000-0002-6736-2255)
- Carla Luzzi (ORCID: https://orcid.org/0000-0001-8641-3161)
- Mureo Kasahara (ORCID: https://orcid.org/0000-0002-1651-0430)
- Dimitri Bezinover
- Tarunjeet Klair (ORCID: https://orcid.org/0000-0002-6718-5404)
- Cynthia Tsien (ORCID: https://orcid.org/0000-0002-9807-3843)
- Timuçin Taner (ORCID: https://orcid.org/0000-0003-0641-2930)
- Mary Vyas
- Marios Ghobrial (ORCID: https://orcid.org/0000-0001-8791-9041)
- Therese Bittermann (ORCID: https://orcid.org/0000-0002-8576-0193)
- Roberto Hernandez‐Alejandro (ORCID: https://orcid.org/0000-0002-2312-3498)
- Kim M. Olthoff (ORCID: https://orcid.org/0000-0001-5181-7502)
- Charles L. Wiggins (ORCID: https://orcid.org/0000-0002-0661-8261)
- Nancy L. Ascher (ORCID: https://orcid.org/0000-0002-7039-4514)
- Tommy Ivanics (ORCID: https://orcid.org/0000-0002-1312-4470)
- Valeria R. Mas (ORCID: https://orcid.org/0000-0001-9297-9751)
- Jan Lerut (ORCID: https://orcid.org/0000-0003-4015-463X)
- Dong‐Sik Kim (ORCID: https://orcid.org/0000-0002-0608-1580)
- Chao‐Long Chen (ORCID: https://orcid.org/0000-0003-0566-9312)
- Nazia Selzner
- Hiroto Egawa (ORCID: https://orcid.org/0000-0002-2298-7438)
- Olivier Scatton
- C Don
- Anand Ghanekar
- M Rela
- Amir Sayed Blayne
Institutions
- University of Modena and Reggio Emilia (IT)
- University of Iowa (US)
- University of Maryland, Baltimore (US)
- Amrita Institute of Medical Sciences and Research Centre (IN)
- Medanta The Medicity (IN)
- University Health Network (CA)
- Mayo Clinic (US)
- University of Padua (IT)
- The University of Texas at San Antonio Health Science Center (US)
- Royal Free London NHS Foundation Trust (GB)
- University of California, San Francisco (US)
- University of Toronto (CA)
- Korea University (KR)
- Hospital of the University of Pennsylvania (US)
- Tamil Nadu Dr. M.G.R. Medical University (IN)
- King Faisal Specialist Hospital & Research Centre (SA)
- Jacksonville College (US)
- Toronto General Hospital (CA)
- University of Rochester Medical Center (US)
- Sorbonne Université (FR)
- University of Chicago (US)
- Health First (US)
- Kaohsiung Chang Gung Memorial Hospital (TW)
- Assistance Publique – Hôpitaux de Paris (FR)
- Azienda Ospedaliero-Universitaria di Modena (IT)
- Methodist Hospital (US)
- University of California San Francisco Medical Center (US)
- Pitié-Salpêtrière Hospital (FR)
- Penn Center for AIDS Research (US)
- Whittington Health NHS Trust (GB)
- National Center For Child Health and Development (JP)
- Tokyo Women's Medical University (JP)
- Parkinson Canada (CA)
- Mayo Clinic in Florida (US)
- University of Pennsylvania (US)
- UCLouvain (BE)
Publication Details
- Journal
- Liver Transplantation
- Published
- 2025-12-18
- DOI
- https://doi.org/10.1097/lvt.0000000000000791
- Primary Topic
- Organ Transplantation Techniques and Outcomes
- Type
- article
- Field-Weighted Citation Impact
- 0.00