Citations 2
Living liver donor safety: Early postoperative considerations of living liver donation guidelines from the ILTS-iLDLTG consensus conference
Sayed, Blayne Amir, Tejedor, Marta , Kathirvel, Manikandan , Bhangui, Prashant , Ghanekar, Anand, Kasahara, Mureo , Scatton, Olivier, Ghobrial, Mark, Klair, Tarunjeet , Rajakumar, Akila , Bezinover, Dimitri , Bittermann, Therese , Don, C, Luzzi, Carla , Tsien, Cynthia , Egawa, Hiroto , Ascher, Nancy L. , Bröering, Dieter C. , Chen, Chao‐Long , Lerut, Jan , Mas, Valeria R. , Taner, Timuçin , Vyas, Mary, Wiggins, Chantal, Olthoff, Kim M. , Rela, M, Selzner, Nazia, Sayed, Blayne A. , Bhangui, Prashant , Rammohan, Ashwin , Selzner, Nazia , Tejedor, Marta , Sayed, Blayne A , Chadha, Ryan , Ivanics, Tommy , Kim, Dong‐Sik , Scatton, Olivier , Ghobrial, Mark, Sudhindran, S , Benedetto, Fabrizio Di , Burra, Patrizia , Hirschfield, Gideon M. , Terrault, Norah A. , Wiggins, Chantal, Fung, John J. , Heimbach, Julie K. , Selzner, Nazia
Liver Transplantation | December 18, 2025 | Volume: 32 | Issue: 6 | Pages: 913-924
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.
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.