Citations 2
Living liver donor safety: Intraoperative considerations in living liver donation—Guidelines from the ILTS–iLDLT group consensus conference 2025
Bhangui, Prashant , Hakeem, Abdul Rahman , Maira, Tommaso Di , Rammohan, Ashwin, Sayed, Blayne A. , Soejima, Yuji , Shingina, Alexandra , Cheah, Yee Lee , McCluskey, Stuart, Spiro, Michael , Ganesh, Swaytha , Rajalingam, Rajesh , Gupta, Subash , Findlay, James Y. , Chieh, Alfred Kow Wei, Sakamoto, Seisuko, Xia, Qiang, Kim, Ki-Hun , Polak, W., Soin, A G, Pomposelli, James J. , Vyas, Mary, Wiggins, Chantal, Mas, Valeria, Taner, Timucin, Broering, Dieter, Chen, Chao-Leng, Burra, Patrizia, Ascher, N. L., Lerut, Jan, Rela, Mohamed, Selzner, Nazia, Balci, Deniz, Olthoff, Kim M. , Polak, Wojciech G. , Hakeem, Abdul , Rammohan, Ashwin , Sayed, Blayne A , McCluskey, Stuart , Findlay, James, Sakamoto, Seisuko , Xia, Qiang , Polak, Wojciech G , Sapisochin, Gonzalo , Pomposelli, James , Selzner, Nazia , Balci, Deniz , Bhangui, Prashant , Di Maira, Tommaso , Gupta, Amar C. , Xia, Qiang , Sapisochín, Gonzalo , Soin, Arvinder S., Taner, Timuçin , Bröering, Dieter C. , Terrault, Norah A. , Burra, Patrizia , Hirschfield, Gideon M. , Lerut, Jan , Rela, Mohamed , Heimbach, Julie K. , Selzner, Nazia
Liver Transplantation | January 5, 2026 | Volume: 32 | Issue: 4 | Pages: 592-608
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.
Post Living Donor Liver Transplantation Small-for-size Syndrome: Definitions, Timelines, Biochemical, and Clinical Factors for Diagnosis: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference
Kow, Alfred Wei Chieh , Martin, Eléonora De , Soejima, Yuji , Watt, Kymberly D. , Xia, Qiang , Saraf, Neeraj, Kamel, Refaat, Srinvasan, Parthi, Elsabbagh, Ahmed M. , Pamecha, Vinayendra, Palaniappan, Kumar , Mas, Valeria R. , Tokat, Yaman , Asthana, Sonal , Cherukuru, Ramkiran , Egawa, Hiroto , Lerut, Jan , Bröering, Dieter C. , Berenguer, Marina , Cattral, Mark S. , Clavien, Pierre‐Alain , Chen, Chao‐Long , Shah, Samir , Zhu, Zhi‐Jun , Emond, Jean C. , Ascher, Nancy L. , Rela, Mohamed , Kim, Dong‐Sik , Ikegami, Toru , Group, On behalf of the ILTS-iLDLT-LTSI SFSS Working, Watt, Kymberly, Berenguer, Marina , Liu, Jiang , Patel, Madhukar S. , Reddy, Mettu Srinivas , Syn, Nicholas L. X. , Nasralla, David , McKenna, Greg J. , Palaniappan, Kumar , Asthana, Sonal , Rammohan, Ashwin , Bhangui, Prashant , Group, On behalf of the ILTS-iLDLT-LTSI SFSS Working
Transplantation | September 26, 2023 | Volume: 107 | Issue: 10 | Pages: 2226-2237
Background. When a partial liver graft is unable to meet the demands of the recipient, a clinical phenomenon, small-for-size syndrome (SFSS), may ensue. Clear definition, diagnosis, and management are needed to optimize transplant outcomes. Methods. A Consensus Scientific committee (106 members from 21 countries) performed an extensive literature review on specific aspects of SFSS, recommendations underwent blinded review by an independent panel, and discussion/voting on the recommendations occurred at the Consensus Conference. Results. The ideal graft-to-recipient weight ratio of ≥0.8% (or graft volume standard liver volume ratio of ≥40%) is recommended. It is also recommended to measure portal pressure or portal blood flow during living donor liver transplantation and maintain a postreperfusion portal pressure of <15 mm Hg and/or portal blood flow of <250 mL/min/100 g graft weight to optimize outcomes. The typical time point to diagnose SFSS is the postoperative day 7 to facilitate treatment and intervention. An objective 3-grade stratification of severity for protocolized management of SFSS is proposed. Conclusions. The proposed grading system based on clinical and biochemical factors will help clinicians in the early identification of patients at risk of developing SFSS and institute timely therapeutic measures. The validity of this newly created grading system should be evaluated in future prospective studies.