• Zhihao Li, Ashwin Rammohan, Vasanthakumar Gunasekaran, Suyoung Hong, Itsuko Chih-Yi Chen, Jongman Kim, Kris Ann Hervera Marquez, Shih Chao Hsu, Elvan Onur Kirimker, Nobuhisa Akamatsu, Oren Shaked, Michele Finotti, Marcus Yeow, Lara Genedy, Philipp Dutkowski, Silvio Nadalin, Markus U Boehnert, Wojciech G Polak, Glenn K Bonney, Abhishek Mathur, Benjamin Samstein, Jean C Emond, Giuliano Testa, Kim M Olthoff, Charles B Rosen, Julie K Heimbach, Timucin Taner, Tiffany Cl Wong, Chung-Mau Lo, Kiyoshi Hasegawa, Deniz Balci, Mark Cattral, Gonzalo Sapisochin, Nazia Selzner, Long Bin Jeng, Dieter Broering, Jae-Won Joh, Chao-Long Chen, Kyung-Suh Suk, Mohamed Rela, and Pierre-Alain Clavien.
• Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Switzerland.
• Ann. Surg. 2023 Nov 1; 278 (5): 798806798-806.

ObjectiveTo define benchmark values for adult-to-adult living-donor liver transplantation (LDLT).BackgroundLDLT utilizes living-donor hemiliver grafts to expand the donor pool and reduce waitlist mortality. Although references have been established for donor hepatectomy, no such information exists for recipients to enable conclusive quality and comparative assessments.MethodsPatients undergoing LDLT were analyzed in 15 high-volume centers (≥10 cases/year) from 3 continents over 5 years (2016-2020), with a minimum follow-up of 1 year. Benchmark criteria included a Model for End-stage Liver Disease ≤20, no portal vein thrombosis, no previous major abdominal surgery, no renal replacement therapy, no acute liver failure, and no intensive care unit admission. Benchmark cutoffs were derived from the 75th percentile of all centers' medians.ResultsOf 3636 patients, 1864 (51%) qualified as benchmark cases. Benchmark cutoffs, including posttransplant dialysis (≤4%), primary nonfunction (≤0.9%), nonanastomotic strictures (≤0.2%), graft loss (≤7.7%), and redo-liver transplantation (LT) (≤3.6%), at 1-year were below the deceased donor LT benchmarks. Bile leak (≤12.4%), hepatic artery thrombosis (≤5.1%), and Comprehensive Complication Index (CCI ® ) (≤56) were above the deceased donor LT benchmarks, whereas mortality (≤9.1%) was comparable. The right hemiliver graft, compared with the left, was associated with a lower CCI ® score (34 vs 21, P < 0.001). Preservation of the middle hepatic vein with the right hemiliver graft had no impact neither on the recipient nor on the donor outcome. Asian centers outperformed other centers with CCI ® score (21 vs 47, P < 0.001), graft loss (3.0% vs 6.5%, P = 0.002), and redo-LT rates (1.0% vs 2.5%, P = 0.029). In contrast, non-benchmark low-volume centers displayed inferior outcomes, such as bile leak (15.2%), hepatic artery thrombosis (15.2%), or redo-LT (6.5%).ConclusionsBenchmark LDLT offers a valuable alternative to reduce waitlist mortality. Exchange of expertise, public awareness, and centralization policy are, however, mandatory to achieve benchmark outcomes worldwide.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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