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    Living donor liver transplantation: A multi-disciplinary collaboration towards growth, consensus, and a change in culture
    (Wiley, 2023) Liapakis, AnnMarie; Jesse, Michelle T.; Pillai, Anjana; Bittermann, Therese; Dew, Mary Amanda; Emre, Sukru; Hunt, Heather
    IntroductionLiving donor liver transplantation (LDLT) reduces liver transplant waitlist mortality and provides excellent long-term outcomes for persons with end stage liver disease. Yet, utilization of LDLT has been limited in the United States (US). MethodsIn October 2021, the American Society of Transplantation held a consensus conference to identify important barriers to broader expansion of LDLT in the US, including data gaps, and make recommendations for impactful and feasible mitigation strategies to overcome these barriers. Domains addressed encompassed the entirety of the LDLT process. Representation from international centers and living donor kidney transplantation were included for their perspective/experience in addition to members across disciplines within the US liver transplantation community. A modified Delphi approach was employed as the consensus methodology. ResultsThe predominant theme permeating discussion and polling results centered on culture; the beliefs and behaviors of a group of people perpetuated over time. ConclusionsCreating a culture of support for LDLT in the US is key for expansion and includes engagement and education of stakeholders across the spectrum of the process of LDLT. A shift from awareness of LDLT to acknowledgement of benefit of LDLT is the primary goal. Propagation of the maxim LDLT is the best option is pivotal.
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    A survey of transplant providers regarding attitudes, barriers, and facilitators to living donor liver transplantation in the United States
    (Wiley, 2023) Liapakis, AnnMarie; Agbim, Uchenna; Bittermann, Therese; Dew, Mary Amanda; Deng, Yanhong; Gan, Geliang; Emre, Sukru
    IntroductionA successful living donor liver transplant (LDLT) is the culmination of a multifaceted process coordinated among key stakeholders. MethodsWe conducted an electronic survey of US liver transplant (LT) centers (August 26, 2021-October 10, 2021) regarding attitudes, barriers, and facilitators of LDLT to learn how to expand LDLT safely and effectively in preparation for the American Society of Transplantation Living Donor Liver Transplant Consensus Conference. ResultsResponses were received from staff at 58 programs (40.1% of US LT centers). There is interest in broadening LDLT (100% of LDLT centers, 66.7% of non-LDLT centers) with high level of agreement that LDLT mitigates donor shortage (93.3% of respondents) and that it should be offered to all suitable candidates (87.5% of respondents), though LDLT was less often endorsed as the best first option (29.5% of respondents). Key barriers at non-LDLT centers were institutional factors and surgical expertise, whereas those at LDLT centers focused on waitlist candidate and donor factors. Heterogeneity in candidate selection for LDLT, candidate reluctance to pursue LDLT, high donor exclusion rate, and disparities in access were important barriers. ConclusionFindings from this study may help guide current and future expansion of LDLT more efficiently in the US. These efforts require clear and cohesive messaging regarding LDLT benefits, engagement of the public community, and dedicated resources to equitably increase LDLT access.