Report of Donors of Living Donor Liver Transplantation at Dr. Cipto Mangunkusumo Hospital Jakarta: an Emerging Liver Transplant Center

Abstract

Introduction: LDLT has developed over the years, despite limited donation rate. Evaluation of living donor is important because there are many risks arise in operating such patients. Thorough evaluation is needed to assess the risks and safety outcomes of the donor and graft adequacy for the recipient. Setting up the liver transplantation program in a developing country like ours was challenging Method: We retrospectively reviewed our living donor patients between 2011-2019. Result: As an emerging liver transplant center, Cipto Mangunkusumo is the first hospital able to routinely perform LDLT successfully in Indonesia. Until 2019, we have successfully performed 53 LDLT; seven were adults and 46 were pediatrics. Main indications for liver transplantation in our institution were biliary atresia and HCC. Mean donor age was 31 years old, the majority of the donor was female. Only one person was an acquaintance donor, others were biologically related. ABO-incompatibility occurred in 1 adult and 2 pediatric patients. Mean of BMI was 22,5 kg/m2. Mild fatty liver was found in 24 donors.. We ran CT-volumetry and biliary tree evaluation using MRCP preoperatively. Mean actual GRWR was 2.5%. We performed right lobe hepatectomy in four patients, the rest were left segmentectomy Length of donor surgery was 393 minutes with 326 cc of mean intra-operative hemorrhage. Two donors have 2 portal veins,1 donor has 3 hepatic arteries and 11 donors have 2 bile ducts. The Average length of stay (ALOS) in the ICU was 2.4 days with total ALOS was 8.3 days. There is no donor mortality. Conclusion: LDLT is a major step forward in our hospital. We hope to raise the awareness of live organ donation to increase the number of adult LDLT in Indonesia. Further improvements are needed to establish a set of criteria for living donor liver transplantation that will ensure donor safety.