Korean J Transplant.  2023 Sep;37(3):179-188. 10.4285/kjt.23.0030.

Characteristics of living liver donors in a national referral hospital in Indonesia: a 13-year experience with living donor liver transplantation

• Louise Lalisang AN
• Putra AB
• Zacharia NJ
• Marbun VMG
• Sihardo L
• Syaiful RA
• Ibrahim F
• Jeo WSJ
• Mazni Y
• Putranto AS
• Maurice Lalisang TJ

• KMID: 2546476
• DOI: http://doi.org/10.4285/kjt.23.0030

Abstract

Background
Hepatocellular carcinoma and biliary atresia lead to end-stage liver disease, which requires liver transplantation and is linked to increased mortality. Dr. Cipto Mangunkusumo Hospital is the national referral center in Indonesia and is the only center that routinely performs living donor liver transplantation (LDLT). This study presents the characteristics of living liver donors (LLDs) in Indonesia.
Methods
Using the LDLT registry, we conducted a retrospective analysis of all approved donors from 2010 to 2022. The variables included clinical characteristics of the donors, graft types, and intraoperative and postoperative characteristics.
Results
The LDLT rate has increased from 5.8 to 8.8 procedures/year in the last 8 years. The average age of the 76 LLDs was 31.8 years. They were predominantly female (59%) and lived within a family relationship (90%). Pediatric LDLT was more frequent than adult LDLT (88% vs. 12%, respectively). Most grafts (86%) were obtained by left lateral sectionectomy, with a median ratio of remnant liver volume to total liver volume of 79.5% (range, 47.7%–85.8%) and a mean graft-to-recipient weight ratio of 2.65%±1.21%. The median intensive care unit length of stay (LOS) was 2 days (range, 1–5 days) and the total hospital LOS was 7 days (range, 4–28 days). The complication rate was 23%. No donor mortality was reported.
Conclusions
LDLT in Indonesia has increased over the years. The shortage of donors for adult-to-adult liver transplantation is due to cultural differences and challenges in finding eligible donors. This study aims to explain the eligibility criteria of LLDs and contribute to creating a national policy.

Keyword

Graft; Indonesia; Length of stay; Liver transplantation; Living donors

Figure

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  Fig. 1 Timeline for providing liver transplantation services in Indonesia by Dr. Cipto Mangunkusumo Hospital (CMH)’s liver transplantation team. NCCHD, National Center for Child Health and Development; ped, pediatric; LT, liver transplantation; LDLT, living donor LT; KIFMEC, Kobe International Frontier Medical Center.

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  Fig. 2 Donor selection pathway and examinations that must be completed before performing a transplantation procedure at Dr. Cipto Mangunkusumo Hospital. HAV, hepatitis A virus; IgM, immunoglobulin M; HBs, hepatitis B surface; Ag, antigen; HBc, hepatitis B core; HBe, hepatitis B envelope; HCV, hepatitis C virus; IgG, immunoglobulin G; CMV, cytomegalovirus; HSV, herpes simplex virus; EBV, Epstein-Barr virus; HBV, hepatitis B virus; HCV, hepatitis C virus; RNA, ribonucleic acid; PCR, polymerase chain reaction; VDRL, venereal disease research laboratory; TPHA, treponema pallidum hemagglutination; HIV, human immunodeficiency virus; BT, bleeding time; CT, clotting time (Phase 2A); PT, prothrombin time; APTT, activated partial thromboplastin time; INR, international normalized ratio; ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, gamma-glutamyl transferase; ALP, alkaline phosphatase; ChE, serum cholinesterase; eGFR, estimated glomerular filtration rate; ECG, electrocardiogram; USG, ultrasonography; AFP, alpha fetoprotein; CEA, carcinoembryonic antigen; CA 19-9, carbohydrate antigen 19-9; TGL, triglycerides; HDL, high-density lipoprotein; LDL, low-density lipoprotein; HbA1c, hemoglobin A1C; FT4, free thyroxine; TSH, thyroid stimulating hormone; CT, computed tomography; MRCP, magnetic resonance cholangiopancreatography; MR, magnetic resonance; HCC, hepatocellular carcinoma; PET, positron emission tomography; GI, gastrointestinal; BMD, bone mineral densitometry; ERCP, endoscopic retrograde cholangiopancreatography; BSA, body surface area.

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  Fig. 3 List of other hepatic vein variations other than the ones previously appeared in Fig. 2. LHV, left hepatic vein; MHV, middle hepatic vein; RHV, right hepatic vein; IVC, inferior vena cava.

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