Abstract
Introduction:
Living liver donation improves survival of end-stage liver disease patients. Yet, it continues to represent a small proportion of U.S. liver transplantation with existing racial disparities. We investigated the interplay of donor-recipient relationship and donor race to understand donor subgroups with no significant increase.
Methods:
We studied 4,407 living liver donors in the U.S. from 1/1/2012–12/31/2022 (median age=36 years, and 59% were biologically related to the recipient). We quantified change in number of donors per 3-year increment using negative binomial regression (Incident Rate Ratio, IRR), stratified by donor-recipient relationship and race/ethnicity.
Results:
Among biologically related donors, the observed annual number of White donors increased from 146 to 253, Hispanic donors from 18 to 53, and Black donors from 11 to 10. Among unrelated donors, White donors increased from 65 to 221, Hispanic donors from 4 to 25, and Black donors from 3 to 11. For the IRR of biologically related donors aged <40 and ≥40 years, White donors increased by 18% and 22%; Hispanic donors increased by 25% and 54%; and Black donors did not change. Likewise, the IRR of unrelated donors aged <40 and ≥40 years, White donors increased by 48% and 55%; Hispanic donors increased by 52% and 65%; and Black donors did not change.
Conclusions:
While biologically related donors represent the majority of donors, unrelated donors have substantially risen in recent years, primarily driven by White donors. Although the rate of unrelated donations increased among Hispanic donors, the absolute number remains very small (≤25 donors/year). Interventions are needed to increase education among Hispanic and Black communities to grow unrelated living liver donations across race/ethnicity.
Keywords: Living donors, Liver, Hepatectomy, Family, Racial Groups, Registry
INTRODUCTION
Living liver donation offers a superior survival benefit to patients with end-stage liver disease (ESLD) compared to waiting for a deceased donation.1–4 Over 2,000 candidates on the waitlist are removed yearly in the United States due to death or being too unwell to undergo a transplant,5 illustrating the vital need for living liver donation to increase transplant options. Yet, living donor liver transplantation (LDLT) remains underutilized.5,6 Although the annual number of U.S. living liver donors increased from 247 donors in 2012 to 604 in 2022, it represents only 5% of U.S. liver transplantation with existing racial disparities.7
Individuals who were related to the recipient, White, and younger were more likely to contribute to living liver donations.5 Some donor trends might be understood by the motivation of family members to help the recipient and the lower risk of acute rejection for LDLT from biologically related donors,8 or the surgical complications and higher risk of graft failure for LDLT from older donors.3,9 However, this does not justify the lack of living liver donation for minority racial subgroups. The lower donation rates in these subgroups may stem from modifiable barriers, including lack of education, fewer initial inquiries by potential donors, financial burdens, and geographical disparities.7,10 A knowledge gap exists regarding the interplay of donor-recipient relationship and donor race in living liver donation. Understanding the gaps in living liver donation is critical to improving access to LDLT and reducing waitlist fatalities for patients with ESLD.
We aim to better understand donor subgroups with no significant increase in living liver donation over the last decade that may serve as potential targets for future interventions. We used a stratified regression framework to identify the characteristics of donors – jointly defined by donor-recipient relationship, race/ethnicity, and donor age.
METHODS
Data Source and Study Population
We used the national donor registry, Scientific Registry of Transplant Recipients (SRTR) external release made available in March 2023. The SRTR data system includes data on all donors, waitlist candidates, and transplant recipients in the United States, submitted by members of Organ Procurement and Transplantation Network (OPTN), and has been previously described.11 The Health Resources and Services Administration (HRSA) under the U.S. Department of Health and Human Services provides federal government oversight to the activities of the OPTN and SRTR contractors. This study used deidentified data and was exempted by the University of California Irvine School of Medicine Institutional Review Board. The study population included 4,407 living liver donors between January 1, 2012, and December 31, 2022.
Outcomes
The outcome of interest was the change in the rate of living liver donation over time. A priori, we stratified the analyses by donor-recipient relationship (biologically related and unrelated) and donor race (White/others, Hispanic, and Black) because of historical trends in living donation and existing racial/ethnic disparities in living liver donation. By extension, donor age was categorized as <40 and ≥40 years to reflect younger and older donors, given the donor age distribution in the national donor registry.
Change in Number of Donors from 2012 to 2022
We used negative binomial regression to estimate the change in number of donors per 3-year increment (incidence rate ratio, IRR). The negative binomial regression was based on aggregated data and estimated the change in number of living donors over time within each stratum of donor type (relationship with recipient, race/ethnicity, and age). The choice of negative binomial regression was to account for overdispersion and excess zeros due to the small number of Hispanic and Black donors. The IRR indicates the proportional decline or increase in the number of donors per 3 years. An incline in donor numbers was initially observed in 2012. Thus, data from January 1, 2012, to December 31, 2022, were used to study liver donation over the last decade.
Statistical analysis
All analyses were performed using R Statistical Software (v4.2.2; R Core Team 2022). The median and interquartile range (IQR) were used to describe continuous variables. Confidence intervals are reported as per the method of Louis and Zeger.12 We used a 2-sided α of 0.05 to indicate a statistically significant difference.
RESULTS
Study Population
We identified a total of 4,407 U.S. living liver donors between January 1, 2012, and December 31, 2022. Of those, 59% (N=2,623) of donors were biologically related to the recipient (17.2% were parents, 47.2% were offspring, 16.9% were full siblings, and 18.7% were non-first-degree relative donors). Among biologically related donors, 79% were White, 16% were Hispanic, and 5% were Black.
The remaining 41% (N= 1,784) donors were unrelated donors to the recipient (59.7% were directed donors, 24.2% were non-directed donors, 11.1% were spouses, and 5% were paired donation donors) (Supplementary Appendix, Figure S1). Among unrelated donors, 90% were White, 7% were Hispanic, and 3% were Black. Overall, donors across race/ethnicity were more likely to be younger (<40 years). Hispanic and Black donors were more likely to have less education and higher body mass index (BMI) than White donors (Table 1).
Table 1.
Baseline Characteristics of Living Liver Donors Between January 1, 2012 and December 31, 2022, Stratified by Donor/Recipient Relationship and Race.
| Biologically related (N= 2,623)4 |
Unrelated (N= 1,784)5 |
|||||
|---|---|---|---|---|---|---|
| Characteristica | White (n= 2,064) |
Hispanic (n= 430) |
Black (n= 129) |
White (n= 1,598) |
Hispanic (n= 128) |
Black (n= 58) |
| 55+ | 55 (3) | 8 (2) | 1 (1) | 124 (8) | 4 (3) | 14 (25) |
| Female sex, n (%) | 1,097 (53) | 259 (60) | 67 (52) | 906 (57) | 74 (58) | 21 (36) |
| ≥30 | 296 (14) | 92 (21) | 31 (24) | 226 (14) | 30 (23) | 12 (21) |
| Unknown | 28 (1) | 8 (2) | 2 (1) | 28 (2) | 5 (4) | 1 (2) |
| Unknown | 13 (1) | 7 (2) | 3 (2) | 13 (1) | 1 (1) | 1 (2) |
Abbreviations: IQR, Interquartile Range; BMI, body mass index, calculated as weight in kilograms divided by height in meters squared.
The category of “White” included 94.1% Caucasian, 3.8% Asian, 0.5% American Indian or Alaskan Native, 0.3% Native Hawaiian or other Pacific Islander, and 1.3% multiracial.
Age 0.4% missing.
BMI 0.4% missing.
Observed Number of Living Liver Donors Over the Entire Study Period
The overall annual number of donors increased from 247 in 2012 to 573 in 2022 (132% increase). The change in annual number of donors varied by donor type. From 2012 to 2022, the total number of biologically related donors increased from 175 to 316 (80% increase) and unrelated donors increased from 72 to 257 (257% increase).
Among biologically related donors from 2012 to 2022, the annual number of White donors increased from 146 to 253 (73% increase). Hispanic donors increased from 18 to 53 (194% increase). Black donors decreased from 11 to 10 (9% increase) (Figure 1A). The annual number of donors varied by age group. White donors increased from 105 to 180 for ages under 40 (71% increase), and from 41 to 73 for ages over 40 (78% increase). Hispanic donors increased from 15 to 38 for ages under 40 (2.5-fold increase), and from 3 to 15 for ages over 40 (5-fold increase). Black donors remained the same at 7 for ages under 40 (no change), and from 4 to 3 for for ages over 40 (25% decrease) (Supplementary Appendix, Figure S2 A, C, E).
Figure 1.
Observed Number of Living Liver Donors by Relationship with the Recipient, Stratified by Race/Ethnicity.
Among unrelated donors from 2012 to 2022, the annual number of White donors increased from 65 to 221 (240% increase). Hispanic donors increased from 4 to 25 (525% increase). Black donors increased from 3 to 11 (266% increase) (Figure 1B). The annual number of donors varied by age group. White donors increased from 32 to 112 for ages under 40 (3.5-fold increase), and from 33 to 109 for ages over 40 (3.3-fold increase). Hispanic donors increased from 3 to 12 for ages under 40 (4-fold increase), and from 1 to 13 for Hispanic (13-fold increase). Black donors increased from 0 to 5 for ages under 40, and from 3 to 6 for ages over 40 (2-fold increase) (Supplementary Appendix, Figure S2 B, D, F).
These observed trends of biologically related and unrelated donors were consistent across the OPTN geographic regions, with substantial variations in the number of donors by region (Supplementary Appendix, Figure S3).13
Incident Rate Ratio of Living Liver Donation From 2012 to 2022
The annual number of biologically related donors increased across all race/ethnicity subgroups. For every 3-year increment, the number of biologically related White donors increased by 18% for ages under 40 (IRR 1.131.181.24), and 22% for ages over 40 (IRR 1.131.221.31). The number of biologically related Hispanic donors increased by 25% for ages under 40 (IRR 1.131.251.38), and 54% for ages over 40 (IRR 1.251.541.89). The number of biologically related Black donors did not increase significantly for ages under 40 (IRR 0.861.041.25), and for ages over 40 (IRR 0.841.211.75). (Figure 2A).
Figure 2.
Incident Rate Ratio of Living Liver Donation from 2012 to 2022 by Age, Stratified by Relationship with the Recipient.
Per 3-year change in number of living liver donors estimated from negative regression model. An incidence rate ratio greater than one indicates an incline each year in the number of living liver donors. The number of biologically related and unrelated White and Hispanic donors of all ages increased after 2012.
Similarly, the annual number of unrelated donors increased across all race/ethnicity subgroups. For every 3-year increment, the number of unrelated White donors increased by 48% for ages under 40 (IRR 1.371.481.61), and 55% for ages over 40 (IRR 1.411.551.72). The number of unrelated Hispanic donors increased by 52% for ages under 40 (IRR 1.111.522.08), and 65% for ages over 40 (IRR 1.231.652.21). The number of unrelated Black donors did not increase significantly for ages under 40 (IRR 0.871.321.99), and for ages over 40 (IRR 0.921.281.78) (Figure 2B).
DISCUSSION
In this national study of living liver donors from 2012 to 2022, we show a consistent rise (80% increase) in biologically related donors and reveal a remarkable surge (257%) in unrelated donors, primarily driven by White donors. Although we observed an increase in Hispanic donors driven by younger biologically related, the absolute number of unrelated donors remains very few (≤25 donors/year). Black donors experience no increase for both biologically related and unrelated during the same period. These findings call for efforts to increase education among Hispanic and Black communities to grow unrelated living liver donations across race/ethnicity.5,17,18,19
In contrast to prior studies that showed significant declines among biologically related living kidney donors over the last two decades,14,15 herein we show a sustained increase among biologically related living liver donors. This contrasting phenomenon might be explained, in part, by the evolving knowledge of genetic and familial factors for post-donation kidney disease in living kidney donors,16 whereas such factors have not been reported for living liver donors. Additionally, while the decline in biologically related living kidney donations may be influenced by the rapid rise in paired exchanges which now represent approximately one-fifth of all living donor kidney donations in the United States, it is important to note that the majority of kidney paired donors are unrelated (≥75%) and White (≥70%) donors.17,18 Further, our findings point out a clear distinction in the observed ages among biologically related liver donors, especially for the Hispanic community, where younger individuals are stepping forward. This is understandable given children are more likely to donate to their parents, and thus offspring donors accounted for the majority of biologically related liver donors (47%). On the other hand, the increases in unrelated White living liver donors are consistent with that of unrelated living kidney donors.19 While our findings are consistent with prior studies of increased non-directed living liver donation, herein we illustrate the majority of unrelated donors are directed White living liver donors.20 Notably, persistent heterogeneity remains in LDLT across U.S. transplant regions. This could be driven by center-level investment in supporting skilled liver transplant surgeons and outreach efforts, and thus, there is an opportunity for transplant centers to grow LDLT programs.21,22
Our study highlights the underrepresentation of minority subgroups in unrelated living liver donation, which may be influenced by broader socioeconomic challenges and lack of education disincentivizing living donations.7,10,23 As such, travel time/related expenses, lost wages, and dependent care arrangements associated with donor evaluation and counseling could deter the participation of disadvantaged potential donors.10,24,25 Telemedicine services have the potential to enhance access to living liver donation education and outreach to motivate willing donors.26 Further, we observed a higher proportion of obese donors among Hispanic and Black donors compared to White donors, which may constrict their prospective donor pool.27 Some transplant programs are more willing to consider obese individuals and support them with diet and lifestyle modifications to help expand LDLT.28 Moreover, the higher risk of donor hepatectomy may have contributed to lower acceptance outside of families in the past.29–31 Advancements in minimally invasive techniques are needed to minimize risks associated with donor hepatectomy and appeal to more individuals to donate.32,33
Key strengths of our study include using a national registry to capture the entire population of U.S. donors and isolate the interdependence among biological relationship, race/ethnicity, and age in the trends in living liver donation. That said, our study does have some limitations. The national SRTR database is limited to donors and does not have information on excluded donor candidates. Expanding participation in the SRTR Living Donor Collective is key to understanding evolving trends in candidate-to-donor conversion recognizing that unrelated individuals are more likely to withdraw from the evaluation process.34,35 Because this is a national registry study, we were not able to assess center-level efforts on the observed trends. Nonetheless, we highlight novel lessons: (1) the surge in unrelated living liver donation, which is restricted mostly to white donors. (2) the increase in younger biologically related Hispanic donors. Thus, importantly, our analysis potentially directs future interventions that promote living liver donation by subgroups lacking growth over the last decade.
In conclusion, while biologically related donors make up the majority of donors, the number of unrelated donors has substantially risen in recent years primarily driven by White donors. Our findings highlight the opportunity to grow unrelated donors across race/ethnicity and support equity in access to living liver donor transplantation. This study underscores the need to address modifiable barriers to unrelated living liver donation faced by Hispanic and Black communities and to design culturally sensitive educational programs.
Supplementary Material
ACKNOWLEDGEMENTS
Funding/Support:
This study was supported by the following grants from the National Institute of Diabetes and Digestive and Kidney Diseases, National Heart, Lung and Blood Institute, and National Institute on Aging: K23DK129820 (Al Ammary) and K08AG065520-01 (Muzaale).
The authors thank Eman Umer for her help in literature review.
DISCLOSURE
ANA: PI or co-I of clinical trials sponsored by NIH/NIAID, NeuroRx Pharma, Pulmotect, Blade Therapeutics, Novartis, Takeda, Humanigen, Eli Lilly, PTC Therapeutics, OctaPharma, Fulcrum Therapeutics, Alexion; Speaker and/or consultant for Pfizer, Salix, Alexion, AstraZeneca, Bayer, Ferring, Seres, Spero, Eli Lilly, Nova Nordisk, Gilead, Renibus, GSK, Dexcom,Reprieve, HeartRite, Aseptiscope, all unrelated to this project.
KLL is supported by the Mid-America Transplant endowed chair in transplantation and is a Senior Scientist of the SRTR.
ABBREVIATIONS
- BMI
body mass index
- CI
confidence interval
- ESLD
end-stage liver disease
- HRSA
Health Resources and Services Administration
- IQR
interquartile range
- IRR
Incidence Rate ratio
- OPTN
Organ Procurement and Transplantation Network
- SRTR
Scientific Registry of Transplant Recipients
- UNOS
United Network for Organ Sharing
- U.S.
United States
Footnotes
Disclaimer: The data reported here have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. Government.
Data statement
The data that support the findings of this study are available from the Scientific Registry of Transplant Recipients (SRTR). Restrictions apply to the availability of these data, which were used under license for this study. Data are available from the author(s) with the permission of the Scientific Registry of Transplant Recipients (SRTR).
REFERENCES
- 1.Barbetta A, Aljehani M, Kim M, et al. Meta-analysis and meta-regression of outcomes for adult living donor liver transplantation versus deceased donor liver transplantation. American Journal of Transplantation. 2021;21(7):2399–2412. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Berg CL, Merion RM, Shearon TH, et al. Liver transplant recipient survival benefit with living donation in the model for endstage liver disease allocation era. Hepatology (Baltimore, Md). 2011;54(4):1313–1321. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Humar A, Ganesh S, Jorgensen D, et al. Adult Living Donor Versus Deceased Donor Liver Transplant (LDLT Versus DDLT) at a Single Center: Time to Change Our Paradigm for Liver Transplant. Ann Surg. 2019;270(3):444–451. [DOI] [PubMed] [Google Scholar]
- 4.Jackson WE, Malamon JS, Kaplan B, et al. Survival Benefit of Living-Donor Liver Transplant. JAMA surgery. 2022;157(10):926–932. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Kwong AJ, Ebel NH, Kim WR, et al. OPTN/SRTR 2021 Annual Data Report: Liver. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2023;23(2 Suppl 1):S178–s263. [DOI] [PubMed] [Google Scholar]
- 6.Lentine KL, Tanaka T, Xiao H, et al. Variation in adult living donor liver transplantation in the United States: Identifying opportunities for increased utilization. Clin Transplant. 2023;37(7):e14924. [DOI] [PubMed] [Google Scholar]
- 7.Nobel YR, Forde KA, Wood L, et al. Racial and ethnic disparities in access to and utilization of living donor liver transplants. Liver Transpl. 2015;21(7):904–913. [DOI] [PubMed] [Google Scholar]
- 8.Levitsky J, Goldberg D, Smith AR, et al. Acute Rejection Increases Risk of Graft Failure and Death in Recent Liver Transplant Recipients. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2017;15(4):584–593.e582. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Kanneganti M, Olthoff KM, Bittermann T. Impact of Older Donor Age on Recipient and Graft Survival After LDLT: The US Experience. Transplantation. 2023;107(1):162–171. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.DiMartini A, Dew MA, Liu Q, et al. Social and Financial Outcomes of Living Liver Donation: A Prospective Investigation Within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study 2 (A2ALL-2). American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2017;17(4):1081–1096. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Massie AB, Kucirka LM, Segev DL. Big data in organ transplantation: registries and administrative claims. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2014;14(8):1723–1730. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Louis TA, Zeger SL. Effective communication of standard errors and confidence intervals. Biostatistics (Oxford, England). 2009;10(1):1–2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Organ Procurement and Transplantation Network (OPTN) regions. Available at https://optn.transplant.hrsa.gov/about/regions/. Accessed on Jan 24, 2024.
- 14.Al Ammary F, Bowring MG, Massie AB, et al. The changing landscape of live kidney donation in the United States from 2005 to 2017. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2019;19(9):2614–2621. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Al Ammary F, Adeyemo S, Lentine KL, Muzaale AD. Evolution of Biologically Related Living Kidney Donation in the United States from 1988 to 2022. Journal of the American Society of Nephrology : JASN. 2024;35(8):1104–1106. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Thomas CP, Daloul R, Lentine KL, et al. Genetic evaluation of living kidney donor candidates: A review and recommendations for best practices. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2023;23(5):597–607. [DOI] [PubMed] [Google Scholar]
- 17.Organ Procurement and Transplantation Network: National Data Reports. https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/#. Accessed on Aug 1, 2024.
- 18.Thomas AG, Shaffer AA, Segev DL. Are We Underestimating The Number Of Paired Kidney Exchange Transplants In The United States? Relationship Insights From The National Kidney Registry [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/are-we-underestimating-the-number-of-paired-kidney-exchange-transplants-in-the-united-states-relationship-insights-from-the-national-kidney-registry/. Accessed April 6, 2024. [Google Scholar]
- 19.Al Ammary F, Yu Y, Ferzola A, et al. The first increase in live kidney donation in the United States in 15 years. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2020;20(12):3590–3598. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Herbst LR, Herrick-Reynolds K, Bowles Zeiser L, et al. The Landscape of Nondirected Living Liver Donation in the United States. Transplantation. 2022;106(8):1600–1608. [DOI] [PubMed] [Google Scholar]
- 21.Sturdevant M, Ganesh S, Samstein B, et al. Advances and innovations in living donor liver transplant techniques, matching and surgical training: Meeting report from the living donor liver transplant consensus conference. Clin Transplant. 2023;37(7):e14968. [DOI] [PubMed] [Google Scholar]
- 22.Liapakis A, Agbim U, Bittermann T, et al. A survey of transplant providers regarding attitudes, barriers, and facilitators to living donor liver transplantation in the United States. Clin Transplant. 2023;37(7):e14967. [DOI] [PubMed] [Google Scholar]
- 23.Kanneganti M, Byhoff E, Serper M, Olthoff KM, Bittermann T. Neighborhood-level social determinants of health measures independently predict receipt of living donor liver transplantation in the U.S. Liver Transpl. 2023. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Doyle A, Rabie RN, Mokhtari A, et al. Recipient factors associated with having a potential living donor for liver transplantation. Liver Transpl. 2015;21(7):897–903. [DOI] [PubMed] [Google Scholar]
- 25.Pillai A, Verna EC, Parikh ND, et al. Financial, policy, and ethical barriers to the expansion of living donor liver transplant: Meeting report from a living donor liver transplant consensus conference. Clin Transplant. 2023;37(7):e14955. [DOI] [PubMed] [Google Scholar]
- 26.Al Ammary F, Motter JD, Sung HC, et al. Telemedicine services for living kidney donation: A US survey of multidisciplinary providers. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2022;22(8):2041–2051. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Adult Obesity Facts. Available at https://www.cdc.gov/obesity/data/adult.html. Accessed on Jan 15, 2024.
- 28.Danis N, Weeks SR, Kim A, et al. Noninvasive Risk Stratification for Nonalcoholic Fatty Liver Disease Among Living Liver Donor Candidates: A Proposed Algorithm. Liver Transpl. 2022;28(4):670–677. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Abecassis MM, Fisher RA, Olthoff KM, et al. Complications of living donor hepatic lobectomy--a comprehensive report. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2012;12(5):1208–1217. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Muzaale AD, Dagher NN, Montgomery RA, Taranto SE, McBride MA, Segev DL. Estimates of early death, acute liver failure, and long-term mortality among live liver donors. Gastroenterology. 2012;142(2):273–280. [DOI] [PubMed] [Google Scholar]
- 31.Ghobrial RM, Freise CE, Trotter JF, et al. Donor morbidity after living donation for liver transplantation. Gastroenterology. 2008;135(2):468–476. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Kim JC, Hong SK, Lee KW, et al. Early experiences with developing techniques for pure laparoscopic explant hepatectomy in living donor liver transplantation. Liver Transpl. 2023;29(4):377–387. [DOI] [PubMed] [Google Scholar]
- 33.Broering D, Sturdevant ML, Zidan A. Robotic donor hepatectomy: A major breakthrough in living donor liver transplantation. American Journal of Transplantation. 2022;22(1):14–23. [DOI] [PubMed] [Google Scholar]
- 34.Lentine KL, Dew MA, Xiao H, et al. Factors enabling transplant program participation in the Scientific Registry of Transplant Recipients (SRTR) Living Donor Collective: A national survey. Clin Transplant. 2023;37(4):e14908. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Kasiske BL, Ahn YS, Conboy M, et al. Outcomes of living liver donor candidate evaluations in the Living Donor Collective pilot registry. Clin Transplant. 2021;35(9):e14394. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data that support the findings of this study are available from the Scientific Registry of Transplant Recipients (SRTR). Restrictions apply to the availability of these data, which were used under license for this study. Data are available from the author(s) with the permission of the Scientific Registry of Transplant Recipients (SRTR).