Living liver donor safety: Intraoperative considerations in living liver donation—Guidelines from the ILTS–iLDLT group consensus conference 2025

The success of living donor liver transplantation (LDLT) has bridged the growing gap between organ demand and availability in patients with liver failure or liver cancer. Safety of the living liver donor (LLD) is paramount, and astute intraoperative management plays a critical role in ensuring optimal outcomes for them. Given that intraoperative surgical and anesthesia practices vary widely across centers, the International Liver Transplantation Society (ILTS) and the International Living Donor Liver Transplantation Group (iLDLT Group) convened a global consensus conference in Toronto in March 2025 to develop guidelines for intraoperative management of the LLD. This manuscript details the recommendations on intraoperative considerations for the safety of LLD developed by Working Group II 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. Working Group II focused on intraoperative monitoring, fluid and ventilation strategies, surgical techniques for vascular and biliary division, surgeon and center-specific experience, and intraoperative crises planning. These guidelines aim to support both established and emerging LDLT teams to ensure high-quality and safe intraoperative care for the LLD.

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Publication Details

Journal
Liver Transplantation
Published
2025-12-29
DOI
https://doi.org/10.1097/lvt.0000000000000800
Primary Topic
Organ Transplantation Techniques and Outcomes
Type
article
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article

Living liver donor safety: Intraoperative considerations in living liver donation—Guidelines from the ILTS–iLDLT group consensus conference 2025

Gonzalo Sapisochín, Julie K. Heimbach, W. Polak, Prashant Bhangui et al.
Liver Transplantation
Organ Transplantation Techniques and Outcomes
article

Living liver donor safety: Intraoperative considerations in living liver donation—Guidelines from the ILTS–iLDLT group consensus conference 2025

Gonzalo Sapisochín, Julie K. Heimbach, W. Polak, Prashant Bhangui, Norah A. Terrault, Michael D. Spiro, Blayne Amir Sayed, Gideon M. Hirschfield, Mary Vyas, A G Soin, Kim M. Olthoff, James J. Pomposelli, Tommaso Di Maira, James Y. Findlay, Alfred Kow Wei Chieh, Amar Gupta, Yee Lee Cheah, Ki-Hun Kim, Nazia Selzner, Qiang Xia, Swaytha Ganesh, Ashwin Rammohan, N. L. Ascher, Patrizia Burra, Dieter Broering, Stuart McCluskey, Chao-Leng Chen, Seisuko Sakamoto, Jan Lerut, Mohamed Rela, Subash Gupta, Valeria Mas, Timucin Taner, Alexandra Shingina, Yuji Soejima, Chantal Wiggins, Abdul Rahman Hakeem, Deniz Balci, Rajesh Rajalingam
article en

Abstract

The success of living donor liver transplantation (LDLT) has bridged the growing gap between organ demand and availability in patients with liver failure or liver cancer. Safety of the living liver donor (LLD) is paramount, and astute intraoperative management plays a critical role in ensuring optimal outcomes for them. Given that intraoperative surgical and anesthesia practices vary widely across centers, the International Liver Transplantation Society (ILTS) and the International Living Donor Liver Transplantation Group (iLDLT Group) convened a global consensus conference in Toronto in March 2025 to develop guidelines for intraoperative management of the LLD. This manuscript details the recommendations on intraoperative considerations for the safety of LLD developed by Working Group II 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. Working Group II focused on intraoperative monitoring, fluid and ventilation strategies, surgical techniques for vascular and biliary division, surgeon and center-specific experience, and intraoperative crises planning. These guidelines aim to support both established and emerging LDLT teams to ensure high-quality and safe intraoperative care for the LLD.

Liver TransplantationVol. 32(4)
Tufts University (US), Hebron University (PS), University of Maryland, Baltimore (US), Bahçeşehir University (TR), Medanta The Medicity (IN), University Health Network (CA), Mayo Clinic (US), Shinshu University (JP), University of Padua (IT), University of California, San Francisco (US), Shanghai Jiao Tong University (CN), University of Toronto (CA), University of Michigan (US), Renji Hospital (CN), King Faisal Specialist Hospital & Research Centre (SA), The Royal Free Hospital (GB), Hospital for Sick Children (CA), Asan Medical Center (KR), Erasmus MC (NL), Baylor University Medical Center (US), Hospital Universitari i Politècnic La Fe (ES), University of Ulsan (KR), Kaohsiung Chang Gung Memorial Hospital (TW), Methodist Hospital (US), University of California San Francisco Medical Center (US), King's College Hospital NHS Foundation Trust (GB), Medanta The Medicity (IN), Institute of Liver and Biliary Sciences (IN), Vall d'Hebron Hospital Universitari (ES), National Center For Child Health and Development (JP), University of Pittsburgh Medical Center (US), National University Hospital (SG), Erasmus MC Cancer Institute (NL), PSC Partners Seeking a Cure (US), University College London (GB), University of Pennsylvania (US), Bharath University (IN), UCLouvain (BE)
Partnerships for the goals
Openalex Percentile: Top 24%
Organ Transplantation Techniques and Outcomes
DOISourceOpenAlex
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