International Liver Transplantation Society
2025 Toronto Consensus Conference
ILTS-iLDLT Living Liver Donor Safety: Short & Longterm Outcome Consensus Conference 2025
- #ILTSConsensus2025
- Toronto
- March 14, 2025
About the Event
ILTS-iLDLT Living Liver Donor Safety: Short & Longterm Outcome
For children and adults with liver failure and end-stage liver disease, living donor liver transplantation (LDLT) is a proven treatment option, with lower waiting list mortality and morbidity, as well as equivalent or superior allograft and patient survival than deceased-donor liver transplantation. Central to the growth and success of a living liver donor program is careful evaluation of the potential donor, including medical, surgical, and psychosocial history to ensure safety of these donors. It is important to the process to convey the potential short and long-term impact of undergoing a surgical procedure that is not needed for their own health, but instead for the benefit of another. While short term outcomes of living liver donors is known, longterm (5 years) outcomes including medical, surgical, psychosocial, pregnancy, infant and maternal outcomes is less known. Currently, there is a paucity of granular data demonstrating long-term outcomes and overall safety specifically in the otherwise ‘healthy’ living liver donor population. There is a need to bring together experts involved in the workup, selection, surgical procedure and follow up of living donors. They need to review, discuss, and reach agreement on safe practice of living donation surgery and short- and long-term outcomes of living donors. The consensus is attended by a select group of senior medical professionals (including surgeons, hepatologists, radiologists, anesthesiologists, scientists, nurses and patient advocates).
Working Groups Will Cover the Following Aspects...
- WG-I: Pre-operative Aspects to Living Liver Donation
- WG-II: Peri-operative Consideration in Living Liver Donation
- WG-III: Early Post-operative Considerations in Living Liver Donation
- WG-IV: Post-Living Liver Donation: Long- Term Considerations
WG chair: Nazia Selzner
WG members: Tiffany Wong, Toru Ikegami, Mettu Srinivas Reddy, Yaman Tokat, Tomoharu Yoshizumi, Anji Wall, Gokhan Kabacam, Vicky Ng (ped tx hepatologist), Swaytha Ganes, Francois Durand, Ted Sakai, Pooja Bhangui, Eric Yao (hematology), Kartik Jhaveri (Radiology), Susan Abbey(psych), Heather Bedanoch (patient partner)
VG: Madhukar Patel, Paolo Magistri, Qasim Khan
TOPICS for WG1
- Who’s an ideal donor?
- Age, ABO, BMI, etc.
- What are the acceptable comorbidities?
- Medical contraindications for donation?
- Drug history? – neurological, allergies etc.
- Assessment of liver quality
- LFT
- Acceptable limits – derangements before donation?
- Assessment of steatosis in the donor? (MRI, Fibroscan, LAI, biopsy etc)
- Acceptable limits
- Interventions – to improve liver status
- Procoagulant work-up? Mandatory, what should be done? Family history? Etc.
- Disease specific work-up and extended tests?
- Anatomical considerations
- Mandatory radiological work-up.
- Is MRI is it mandatory?
- Absolute contraindication to donation
- Implications for donor outcome / for recipient outcome
- Safe remnant
- Absolute contraindication
- Relative contraindications
- Optimizing remnant
- Previous surgery – previous donations
- Acceptability consideration
- Mandatory radiological work-up.
- LFT
WG Chair: Kim Olthoff
Panelists: Ki Hun-Kim, Dieter Broering, Subash Gupta, James Pomposelli, Deniz Balci, Yuji Soejima, Alfred Kow, Anand Ghanekar, Avi Humar, Rajesh Rajalingam, Stuart McClusky, Jim Findlay, Nicolas Goldaracena, Nancy Kwan Man
VG: Abdul Hakeem, Alexandra Shingina, Tommaso DiMaira
TOPICS for WG2
- Anesthesia
- Standardized access and what should be minimal monitoring? (Central venous access, arterial line)
- Locoregional pain control: may reference prior ERAS conference work
2. Surgery
- Training requirements for ODH, PLDH and RDH. Centre volume – ideal number.
- What are the standard surgical techniques? Incision – ideal for ODH
- Inflow control, parenchymal transection techniques- best/preferred, bile duct visualization -ICG, IOC, bile duct division, drain placement?
- MIS utilization: robotic vs lap? Bile duct division in MIDH
- Standardized intra-op disaster pathway: in open/lap/robotic – uncontrolled hemorrhage or severe HD instability
WG Chair: Julie Heimbach
Panelists: Dong-Sik Kim, Gonzalo Sapisochin, Mureo Kasahara, Mark Ghobrial, Tarunjeet Klair, Akila Rajakumar, Dimtri Bezinovir, Cynthia Tsien, Gary May (advanced endoscopy), UHN IR, Tess Bitterman, Anne Marie Lapinski, Caitlin Don, Sudhindran
VG: Ryan Chadha, Manikandan Kathirvel, Tommy Ivanics
TOPICS for WG-III
- Anesthesia & Hepatology
- Requirements for 24 Monitoring, pain control, diet advancement, fluid management, ERAS pathway – applications
- Mandatory protocols – Blood tests (LFTs, lactate) imaging USG-frequency, Triggers for CT
- Prophylaxis: Antibiotics, DVT, Ulcer—what and for how long
- Surgery
- Management of early complications
- Biliary – Drain bilirubin, Indications & timing of ERCP Reexploration,
- Management of Bleed
- Triggers for reexploration
- Management of insufficient functional liver remnant – criteria for PHLF, threshold for consideration of LT
- Management of other serious medical complications: PE, pancreatitis,
- Standardized post-op disaster plan – Donor mortality
3. Psychiatry & Ethics
- Timing of Return to work, exercise, driving, sexual health
- Donors with Post-operative depression or anxiety
Sharing news of poor recipient outcome with donors
WG Chair: Mohamed Rela
Panelists: Zhi-jun Zhu, Elizabeth Pomfret, Avi Soin, Markus Selzner, Jongman Kim, Bijan Eghtesad, Daniel Maluf, Susan Abbey (psych)(another name), Kym Watt, Anjana Pillai, Sudha Kodali, Paul James (advanced endoscopy), John Roberts, Susumu Eguchi, Albert Chan
VG: Sadhana Shankar, Johns Shaji Mathew, Nicholas Syn
- Hepatology & Surgery
- Defining standard long-term follow-up benchmarks
- Review protocols- Minimum requirement
- Mandatory frequency, blood tests, imaging etc.
- Management of Late Complications
- Biliary strictures
- Diaphragmatic Hernia
- Wound complications
- Chronic pain
- Psychiatry & Ethics
- Quality of Life, Body Image, Sexual & Reproductive health
- Long term psychosocial support – suicides, recipient deaths etc
- Istanbul declaration
- International LDLT donor registry
Jury:
Jed Gross
Chantal Wiggins
Hiroto Egawa
Nancy Ascher
Valeria Mas
John Fung
Norah Terrault
Kyung Suk-Suh
Chao-Long Chen
Patrizia Burra
Consensus Conference Begins in...
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Interested in being a part of the Toronto Consensus as a Sponsor?
ILTS Executive Committee 2024-2025
Nazia Selzer
ILTS President
Valeria Mas
ILTS President-Elect
R.Mark Ghobrial
Past President
François Durand
Secretary
Bijan Eghtesad
Treasurer
iLDLT Leadership
Kim M Olthoff
President
Kwang Woong Lee
Secretary General
James Pomposelli
Executive Secretary
Conference Chairs
Nazia Selzner
Canada
Kim Olthoff
USA
Mohamed Rela
India
Julie Heimbach
USA
Scientific Committee Chairs
Prashant Bhangui
India
Ashwin Rammohan
India
Blayne Amir Sayed
Canada