Excellent outcomes of living donor liver transplantation: A contemporary report from Western Center

Background and Aims: Living donor liver transplantation (LDLT) helps address organ shortages but remains complex, particularly in Western countries where deceased donor liver transplantation (DDLT) is preferred. This study evaluates improvements in LDLT outcomes over time for both donors and recipients. Study Design: A single-center retrospective analysis from 2001–2023 including two periods: P-ONE (2001–2003, 36 cases) and P-TWO (2020–2023, 27 cases). Donor surgery after October 2022 marked the shift to a full robotic approach. Recipient procedures preserved the retro-hepatic vena cava, with standard vascular and biliary reconstruction. Comparisons include demographics, complications, and survival. Results: P-ONE donors were younger (median age 32 vs. 46, P=0.003), while P-TWO recipients were older (63 vs. 56 years, P=0.005) with more comorbidities. P-TWO had more cases of hepatocellular carcinoma and low-MELD cirrhosis. Donor safety improved in P-TWO, with similar major complication rates (14% vs. 11%). Recipients in P-TWO had fewer severe complications (7% vs. 81%, P<0.001) and better 3-year graft survival. Conclusions: Advances in patient selection, minimally invasive surgery, and perioperative care have significantly improved LDLT outcomes. Despite persistent biliary challenges, LDLT remains a promising solution for end-stage liver disease and liver cancer.