Expanding the living donor pool using domino liver transplantation: a systematic review

Introduction: To this day, a discrepancy exists between donor liver demand and supply. Domino liver transplantation (DLT) can contribute to increasing the number of donor livers available for transplantation. Methods: The design of this systematic review was based on the Preferred Reporting Items for Systematic Reviews (PRISMA). A qualitative analysis of included studies was performed. Primary outcomes were mortality and peri- and postoperative complications related to DLT. Results: Twelve studies met the inclusion criteria. All included studies showed that DLT outcomes were comparable to outcomes of deceased donor liver transplantation (DDLT) in terms of mortality and complications. One-year patient survival rate ranged from 66.7% to 100%. Re-transplantation rate varied from 0 to 12.5%. Most frequent complications were related to biliary (3.7%–37.5%), hepatic artery (1.6%–9.1%), portal vein (12.5–33.3%) and hepatic vein events (1.6%), recurrence of domino donor disease (3.3%–17.4%) and graft rejection (16.7%–37.7%). The quality of the evidence was rated as moderate according to the Newcastle–Ottawa scale (NOS). Conclusion: DLT outcomes were similar to DDLT in terms of mortality and complications. Even though DLT will not solve the entire problem of organ shortage, transplant programs should always consider using this tool to maximize the availability of liver grafts.