Evolving trends and outcomes in living and deceased donor liver transplantation: institutional experience from Changwon Hanmaeum Hospital (2023–2025)

Background: Liver transplantation (LT) is the definitive treatment for end-stage liver disease, acute liver failure, and selected cases of hepatocellular carcinoma. Despite global advances, institutional experience remains critical for optimizing outcomes. This study describes LT outcomes at Changwon Hanmaeum Hospital, South Korea, over a 2.5-year period. Methods: A retrospective review was conducted of all LTs performed between January 2023 and July 2025. Demographic characteristics, primary diagnoses, model for end-stage liver disease (MELD) scores, Child-Turcotte-Pugh classifications, ischemic times, graft types, surgical details, postoperative complications, and survival outcomes were analyzed. Outcomes were compared between living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT), and between early (2023-2024) and recent (2025) cases. Results: A total of 56 LTs were performed, including 29 LDLT and 27 DDLT procedures. The mean recipient age was 45 years in the LDLT group and 52 years in the DDLT group. Alcoholic cirrhosis (39.3%) and hepatitis B-related cirrhosis (26.8%) were the most common indications. MELD scores were higher in DDLT recipients than in LDLT recipients. Mean cold ischemic time was 141.7 minutes in LDLT and 282.2 minutes in DDLT. Laparoscopic donor hepatectomy was attempted in 17 donors (58.6%), with eight conversions (27.6%) to open surgery. Infectious complications predominated, particularly bacterial pneumonia (8.9%). Overall, 46 patients (82.1%) survived to discharge, with improved outcomes observed in 2025 compared with 2023-2024 (90.5% vs. 77.1%). Recipient operative time decreased from 429 to 360 minutes over the study period. Conclusions: LT outcomes improved progressively over the study period, likely reflecting accumulated surgical expertise, adoption of laparoscopic donor techniques, and optimization of perioperative management. Continued training, multidisciplinary collaboration, and systematic program evaluation remain essential for sustainable program development.