Aborted living-donor liver transplantation in the real-world setting, lessons from 13,937 cases of Vanguard Multi-center Study of iLDLT Group.

There are very rare but definite situations where intraoperative abortions are inevitable in living-donor liver transplantation (LDLT) by unexpected or catastrophic events in the real world. This study aimed to summarize the cases of aborted LDLT and propose a strategy to prevent abortion or minimize donor damage from both recipient and donor sides. We collected data from a total of 43 cases of aborted LDLT out of 13,937 cases from 7 high-volume hospitals in the Vanguard Multi-center Study of the international Living Donor Liver Transplantation (iLDLT) Group, and reviewed it retrospectively. Of the 43 cases, there were 24 recipient-related aborted cases and 19 donor-related cases. Recipient-related abortions included pulmonary hypertension (n=8), hemodynamic instability (n=6), advanced HCC (n=5), bowel necrosis (n=4), and severe adhesion (n=1). Donor-related abortions included graft steatosis (n=7), graft fibrosis (n=5), primary biliary cholangitis (n=3), anaphylactic shock (n=2), and hemodynamic instability (n=2). Total incidence of aborted LDLT was 0.31%, and there was no remarkable difference between the centers. A strategy to minimize additional donor damage by delaying donor's laparotomy or trying to open recipient's abdomen with a small incision should be effective in preventing some causes of aborted LDLT, such as pulmonary hypertension, advanced cancer, and severe adhesions.