Global variation in living donor liver transplantation practices impacts donor and recipient short-term outcomes: initial insights from the International LDLT Registry

Living donor liver transplantation (LDLT) is crucial for addressing organ scarcity and improving survival and quality of life. Variations in practices and outcomes are influenced by geographic, economic, and cultural factors. This study examined the association between short-term LDLT outcomes and the Human Development Index (HDI), a composite metric ranking countries by life expectancy, education, and income. Data from September 2023 to June 2024 were prospectively collected through the International LDLT Registry, involving 70 institutions from 26 countries. This prospective global cohort included 1575 pairs (3150 cases). Donors from very high HDI regions had a higher prevalence of comorbidities (17.4%) than those from low HDI regions (1.2%; P < .001). High HDI regions showed lower donor complication rates (9.8%) than lower HDI regions (21.4%; P < .001). Multivariable analysis indicated significantly reduced short-term postoperative donor morbidity in very high HDI regions (odds ratio, 0.32; 95% confidence interval, 0.23-0.44; P < .001). Failure-to-rescue rates were substantially higher in low HDI regions (83.3% vs 2.3%; P < .001). The study highlights the significant disparities in LDLT practices and short-term outcomes across HDI levels, emphasizing the need for global cooperation to standardize practices and enhance care quality to ensure equitable access to liver transplantation worldwide.