ILMIY TADQIQOTLAR VA ULARNING YECHIMLARI JURNALI
JOURNAL OF SCIENTIFIC RESEARCH AND THEIR SOLUTIONS
VOLUME 6, ISSUE 01, IYUL 2025
WORLDLY KNOWLEDGE NASHRIYOTI
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LIVING DONOR AND DECEASED DONOR LIVER TRANSPLANTATION: CLINICAL
OUTCOMES AND FUTURE DIRECTIONS
Akhmatov Akhmadulloh Akramjon ugli
Student of Andijan State Medical Institute
Scientific Advisor:
Salahiddinov Kamoliddin Zukhriddinovich
Professor, Department of Faculty and Hospital Surgery
Abstract:
Liver transplantation is the standard of care for patients with end-stage liver disease and
acute hepatic failure. The increasing gap between organ demand and availability has accelerated the
development of living donor liver transplantation (LDLT) as a complementary approach to deceased
donor liver transplantation (DDLT). This study analyzes 250 patients who underwent liver
transplantation between 2016 and 2023, comparing outcomes between LDLT and DDLT, evaluating
postoperative complications, graft survival, and quality of life. The study also examines recent
innovations, including machine perfusion and immunosuppressive strategies. Results demonstrated
comparable one- and five-year survival rates for both groups, with LDLT reducing waiting list
mortality by 35%. Advances in perioperative care and Enhanced Recovery After Surgery (ERAS)
protocols significantly improved postoperative recovery. These findings highlight the vital role of
both living and deceased donor programs in addressing organ shortages and optimizing outcomes in
liver transplantation.
Keywords:
Liver transplantation, Living donor liver transplant, Deceased donor, End-stage liver
disease, Immunosuppression, Graft survival, ERAS.
Introduction
End-stage liver disease is a leading cause of mortality worldwide, and liver transplantation remains
the only definitive therapy for decompensated cirrhosis, acute liver failure, and selected hepatic
malignancies. While deceased donor liver transplantation (DDLT) has historically been the standard
approach, the scarcity of donor organs has prompted the development of living donor liver
transplantation (LDLT).
LDLT provides an immediate organ source, reduces waiting list mortality, and allows elective
scheduling of surgery, making it particularly valuable in regions with low deceased donor
availability. However, LDLT requires meticulous surgical technique and introduces donor safety as
a critical ethical consideration.
This study compares clinical outcomes between LDLT and DDLT, focusing on graft survival,
complications, and postoperative recovery. It also explores future perspectives, including machine
perfusion technology and personalized immunosuppressive regimens.
Materials and Methods
A prospective cohort study was conducted on 250 patients who underwent orthotopic liver
transplantation between January 2016 and December 2023 at two major transplant centers.
Patient Selection
Inclusion criteria included patients with end-stage liver disease (MELD score ≥ 15), acute liver
failure, and hepatocellular carcinoma within Milan criteria. Pediatric patients with biliary atresia and
ILMIY TADQIQOTLAR VA ULARNING YECHIMLARI JURNALI
JOURNAL OF SCIENTIFIC RESEARCH AND THEIR SOLUTIONS
VOLUME 6, ISSUE 01, IYUL 2025
WORLDLY KNOWLEDGE NASHRIYOTI
worldlyjournals.com
metabolic disorders were included. Exclusion criteria consisted of uncontrolled systemic infection,
advanced cardiac dysfunction, and extrahepatic malignancies.
Donor Procurement and Techniques
Among the 250 patients, 150 received deceased donor grafts and 100 underwent living donor liver
transplantation. Deceased donor organs were preserved using University of Wisconsin (UW)
solution or histidine-tryptophan-ketoglutarate (HTK) solution. In LDLT, right or left hepatic lobes
were harvested using intraoperative ultrasound and microsurgical biliary dissection. Machine
perfusion was applied in 30% of deceased donor grafts to assess its effect on ischemia-reperfusion
injury.
Surgical Approach
Orthotopic liver transplantation was performed using the piggyback technique in 70% of cases and
the classical caval replacement method in the remainder. Biliary reconstruction was duct-to-duct in
most adult cases and Roux-en-Y hepaticojejunostomy in pediatric patients and complex anatomies.
Intraoperative Doppler ultrasonography ensured vascular patency.
Immunosuppression and Postoperative Care
All patients received tacrolimus-based triple therapy with corticosteroids and mycophenolate mofetil.
Basiliximab induction was used in selected high-risk patients. Postoperative care included intensive
monitoring, early extubation, and ERAS protocols emphasizing early mobilization and enteral
nutrition.
Data Analysis
Primary endpoints included one- and five-year patient and graft survival. Secondary outcomes were
postoperative complications such as biliary leaks, vascular thrombosis, and acute rejection.
Statistical analysis was conducted using SPSS version 27, applying Kaplan–Meier survival curves
and multivariate regression to identify prognostic factors.
Results
One-year patient survival was 92% in LDLT and 89% in DDLT groups, with five-year survival rates
of 80% and 77%, respectively. Graft survival mirrored these findings. LDLT reduced average
waiting list time from 9.5 months to 2.8 months and decreased waiting list mortality by 35%.
Biliary complications were observed in 14% of LDLT and 11% of DDLT cases. Hepatic artery
thrombosis occurred in 4% of patients overall. Acute rejection episodes were reported in 12% and
successfully managed with corticosteroid boluses and adjustments to immunosuppressive therapy.
Machine perfusion demonstrated improved early allograft function, particularly in marginal donor
grafts, reducing the incidence of early allograft dysfunction compared to static cold storage.
Discussion
The study confirms that both LDLT and DDLT offer excellent long-term outcomes for patients with
liver failure. LDLT’s ability to reduce waiting list mortality and allow timely transplantation makes
ILMIY TADQIQOTLAR VA ULARNING YECHIMLARI JURNALI
JOURNAL OF SCIENTIFIC RESEARCH AND THEIR SOLUTIONS
VOLUME 6, ISSUE 01, IYUL 2025
WORLDLY KNOWLEDGE NASHRIYOTI
worldlyjournals.com
it an essential complement to deceased donor programs, particularly in areas with limited organ
availability.
Machine perfusion represents a promising advancement in donor organ preservation, especially for
extended criteria grafts. ERAS protocols have proven to enhance recovery by minimizing ICU stay,
promoting early mobilization, and reducing complications.
The comparable survival rates between LDLT and DDLT demonstrate the safety and efficacy of
living donor transplantation when performed in experienced centers with meticulous donor selection
and surgical technique. Future research should focus on improving donor safety, refining
immunosuppressive regimens, and exploring regenerative medicine solutions.
Conclusion
Liver transplantation remains a life-saving procedure for end-stage liver disease. Both living and
deceased donor approaches are critical in addressing the increasing demand for organs. LDLT
reduces waiting list mortality and provides outcomes equivalent to DDLT when performed under
strict protocols.
Advancements
in
machine
perfusion,
ERAS
implementation,
and
individualized
immunosuppression have further improved outcomes. The future of liver transplantation lies in
balancing surgical innovation with donor safety, expanding the donor pool through technology, and
exploring regenerative alternatives to meet the growing clinical need.
References:
1.
Starzl, T. E., et al. (1968). Orthotopic liver transplantation. Annals of Surgery, 168(3), 392–
415.
2.
Brown, R. S., et al. (2020). Living versus deceased donor liver transplantation: Outcomes
and ethical considerations. Liver Transplantation, 26(1), 20–32.
3.
Nasralla, D., et al. (2018). Normothermic machine perfusion in liver transplantation. Nature,
557, 50–56.
4.
Tanaka, K., et al. (2019). Advances in living donor liver transplantation. Transplantation
Proceedings, 51(6), 1850–1856.
5.
Kim, W. R., et al. (2021). Global trends in liver transplantation. Hepatology, 73(1), 1–14.
