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.
Tranexamic acid versus placebo to reduce perioperative blood transfusion in patients undergoing liver resection: protocol for the haemorrhage during liver resection tranexamic acid (HeLiX) randomised controlled trial
Karanicolas, Paul J. , Lin, Yulia , McCluskey, Stuart A. , Roke, Rachel , Tarshis, Jordan , Ball, Chad G. , Chaudhury, Prosanto , Dixon, Elijah , Eeson, Gareth, Moulton, Carol-Anne, Nanji, Sulaiman , Porter, Geoff , Ruo, Leyo , Skaro, Anton , Tsang, Melanie E. , Karanicolas, Paul Jack , McCluskey, Stuart , Thorpe, Kevin E. , Cleary, Sean P. , Wei, Alice C. , Guyatt, Gordon
BMJ Open | February 24, 2022 | Volume: 12 | Issue: 2 | Pages: e058850
Introduction Despite use of operative and non-operative interventions to reduce blood loss during liver resection, 20%–40% of patients receive a perioperative blood transfusion. Extensive intraoperative blood loss is a major risk factor for postoperative morbidity and mortality and receipt of blood transfusion is associated with serious risks including an association with long-term cancer recurrence and overall survival. In addition, blood products are scarce and associated with appreciable expense; decreasing blood transfusion requirements would therefore have health system benefits. Tranexamic acid (TXA), an antifibrinolytic, has been shown to reduce the probability of receiving a blood transfusion by one-third for patients undergoing cardiac or orthopaedic surgery. However, its applicability in liver resection has not been widely researched. Methods and analysis This protocol describes a prospective, blinded, randomised controlled trial being conducted at 10 sites in Canada and 1 in the USA. 1230 eligible and consenting participants will be randomised to one of two parallel groups: experimental (2 g of intravenous TXA) or placebo (saline) administered intraoperatively. The primary endpoint is receipt of blood transfusion within 7 days of surgery. Secondary outcomes include blood loss, postoperative complications, quality of life and 5-year disease-free and overall survival. Ethics and dissemination This trial has been approved by the research ethics boards at participating centres and Health Canada (parent control number 177992) and is currently enrolling participants. All participants will provide written informed consent. Results will be distributed widely through local and international meetings, presentation, publication and ClinicalTrials.gov. Trial registration number NCT02261415 .