Intraoperative aborted living donor liver transplantation surgeries, lessons from 13,937 cases of Vanguard multi-center study of international living donor liver transplantation group

Background:We rarely experience these situations where intraoperative abortions are inevitable in living donor liver transplantation (LDLT) by unexpected or catastrophic events in the real world.To date, there has been only a few reports of aborted LDLT in both donors and recipients, and no multi-centric study has been reported.The aim of this study is to summarize the cases of aborted LDLT, and to propose the strategy to prevent the abortion or minimize the donor damage, from the aspect of both recipient and donor sides.Methods: We collected data of totally 43 cases of aborted LDLT from 13,937 cases, with the seven high-volume hospitals from the Vanguard multi-center Study of the international LDLT group, between 2002 and 2021 and reviewed it retrospectively.Results: Of the 43 cases, there were 24 cases of recipient-related aborted LDLT and 19 cases of donor-related.Recipient-related abortions included pulmonary hypertension (n=8), hemodynamic instability (n=6), advanced hepatocellular carcinoma (n=5), bowel necrosis (n=4), and severe adhesion (n=1).In contrast, donor-related abortions were from graft steatosis (n=7), low quality of graft (n=8), anaphylactic shock (n=2), and hemodynamic instability (n=2).In particular, donor-related abortions have been on the rise since 2018.Total incidence of aborted LDLT was 0.31%, and there was no remarkable difference among the centers.Conclusions: For some reasons of aborted LDLT, such as pulmonary hypertension, advanced cancer, severe adhesion, the strategy to minimize the additional donor damage by delaying donors laparotomy or trying to open the recipients abdomen with a small incision must be effective.