Living liver donor safety: Intraoperative considerations in living liver donation guidelines from the ILTS-iLDLT group consensus conference 2025

Prashant Bhangui; Abdul Rahman Hakeem; Tommaso Di Maira; Ashwin Rammohan; Blayne Amir Sayed; Yuji Soejima; Alexandra Shingina; Yee Lee Cheah; Stuart McCluskey; Michael Spiro; Swaytha Ganesh; Rajesh Rajalingam; Subash Gupta; James Findlay; Amar Gupta; Alfred Kow Wei Chieh; Seisuko Sakamoto; Qiang Xia; Ki Hun Kim; Wojciech G. Polak; Gonzalo Sapisochin; Arvinder Singh Soin; James Pomposelli; Mary Vyas; Chantal Wiggins; Valeria Mas; Timucin Taner; Dieter Broering; Chao Leng Chen; Norah Terrault; Patrizia Burra; Gideon Hirschfield; Nancy Ascher; Jan Lerut; Mohamed Rela; Julie Heimbach; Nazia Selzner; Deniz Balci; Kim Olthoff

doi:10.1097/LVT.0000000000000800

Living liver donor safety: Intraoperative considerations in living liver donation guidelines from the ILTS-iLDLT group consensus conference 2025

Prashant Bhangui^*
, Abdul Rahman Hakeem
, Tommaso Di Maira
, Ashwin Rammohan
, Blayne Amir Sayed
, Yuji Soejima
, Alexandra Shingina
, Yee Lee Cheah
, Stuart McCluskey
, Michael Spiro
, Swaytha Ganesh
, Rajesh Rajalingam
, Subash Gupta
, James Findlay
, Amar Gupta
, Alfred Kow Wei Chieh
, Seisuko Sakamoto
, Qiang Xia
, Ki Hun Kim
, Wojciech G. Polak

Gonzalo Sapisochin, Arvinder Singh Soin, James Pomposelli, Mary Vyas, Chantal Wiggins, Valeria Mas, Timucin Taner, Dieter Broering, Chao Leng Chen, Norah Terrault, Patrizia Burra, Gideon Hirschfield, Nancy Ascher, Jan Lerut, Mohamed Rela, Julie Heimbach, Nazia Selzner, Deniz Balci, Kim Olthoff

^*Corresponding author for this work

Surgery

Medanta (The Medicity)
King's College Hospital NHS Foundation Trust
Hepatology and Liver Transplantation Unit
Bharath Institute of Higher Education and Research
University of Toronto
Shinshu University
University of Michigan, Ann Arbor
Houston Methodist Hospital
University Health Network
Royal Free London NHS Foundation Trust
University of Pittsburgh Medical Center
Center for Liver and Biliary Surgery
Mayo Clinic Rochester, MN
Baylor Health Care System
National University Hospital (Singapore)
National Center for Child Health and Development
Shanghai Jiao Tong University
University of Ulsan
University Hospital Bellvitge
Tufts University
PSC Partners
University of Maryland School of Medicine
King Faisal Specialist Hospital and Research Centre
Chang Gung Memorial Hospital
University of California at San Francisco
Azienda Ospedaliera di Padova
Toronto General Hospital
Université catholique de Louvain
Bahcesehir University
University of Pennsylvania

Research output: Contribution to journal › Review article › Academic › peer-review

Abstract

The success of living donor liver transplantation (LDLT) has bridged the growing gap between organ demand and availability in patients with liver failure or liver cancer. Safety of the living liver donor (LLD) is paramount, and astute intraoperative management plays a critical role in ensuring optimal outcomes in them. Given that intraoperative surgical and anesthesia practices vary widely across centers, the International Liver Transplantation Society (ILTS) and the International Living Donor Liver Transplantation Group (iLDLT Group) convened a global consensus conference in Toronto in March 2025 to develop guidelines for intraoperative management of the LLD. This manuscript details the recommendations on intraoperative considerations for the safety of LLD developed by Working Group II of the Consensus Scientific Committee, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for assessment of recommendations, and the Danish model of consensus. Working Group II focused on intraoperative monitoring, fluid and ventilation strategies, surgical techniques for vascular and biliary division, surgeon and center specific experience, and intraoperative crises planning. These guidelines aim to support both established and emerging LDLT teams to ensure high-quality and safe intraoperative care for the LLD.

Original language	English
Journal	Liver Transplantation
Volume	32
Issue number	4
DOIs	https://doi.org/10.1097/LVT.0000000000000800
Publication status	Published - Apr 2026

Bibliographical note

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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10.1097/LVT.0000000000000800

Cite this

Bhangui, P., Hakeem, A. R., Di Maira, T., Rammohan, A., Sayed, B. A., Soejima, Y., Shingina, A., Cheah, Y. L., McCluskey, S., Spiro, M., Ganesh, S., Rajalingam, R., Gupta, S., Findlay, J., Gupta, A., Chieh, A. K. W., Sakamoto, S., Xia, Q., Kim, K. H., ... Olthoff, K. (2026). Living liver donor safety: Intraoperative considerations in living liver donation guidelines from the ILTS-iLDLT group consensus conference 2025. Liver Transplantation, 32(4). https://doi.org/10.1097/LVT.0000000000000800

@article{a27968068e3c4fdb863789485b37078b,

title = "Living liver donor safety: Intraoperative considerations in living liver donation guidelines from the ILTS-iLDLT group consensus conference 2025",

abstract = "The success of living donor liver transplantation (LDLT) has bridged the growing gap between organ demand and availability in patients with liver failure or liver cancer. Safety of the living liver donor (LLD) is paramount, and astute intraoperative management plays a critical role in ensuring optimal outcomes in them. Given that intraoperative surgical and anesthesia practices vary widely across centers, the International Liver Transplantation Society (ILTS) and the International Living Donor Liver Transplantation Group (iLDLT Group) convened a global consensus conference in Toronto in March 2025 to develop guidelines for intraoperative management of the LLD. This manuscript details the recommendations on intraoperative considerations for the safety of LLD developed by Working Group II of the Consensus Scientific Committee, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for assessment of recommendations, and the Danish model of consensus. Working Group II focused on intraoperative monitoring, fluid and ventilation strategies, surgical techniques for vascular and biliary division, surgeon and center specific experience, and intraoperative crises planning. These guidelines aim to support both established and emerging LDLT teams to ensure high-quality and safe intraoperative care for the LLD.",

author = "Prashant Bhangui and Hakeem, \{Abdul Rahman\} and \{Di Maira\}, Tommaso and Ashwin Rammohan and Sayed, \{Blayne Amir\} and Yuji Soejima and Alexandra Shingina and Cheah, \{Yee Lee\} and Stuart McCluskey and Michael Spiro and Swaytha Ganesh and Rajesh Rajalingam and Subash Gupta and James Findlay and Amar Gupta and Chieh, \{Alfred Kow Wei\} and Seisuko Sakamoto and Qiang Xia and Kim, \{Ki Hun\} and Polak, \{Wojciech G.\} and Gonzalo Sapisochin and Soin, \{Arvinder Singh\} and James Pomposelli and Mary Vyas and Chantal Wiggins and Valeria Mas and Timucin Taner and Dieter Broering and Chen, \{Chao Leng\} and Norah Terrault and Patrizia Burra and Gideon Hirschfield and Nancy Ascher and Jan Lerut and Mohamed Rela and Julie Heimbach and Nazia Selzner and Deniz Balci and Kim Olthoff",

note = "Publisher Copyright: {\textcopyright} 2025",

year = "2026",

month = apr,

doi = "10.1097/LVT.0000000000000800",

language = "English",

volume = "32",

journal = "Liver Transplantation",

issn = "1527-6465",

publisher = "Lippincott Williams \& Wilkins",

number = "4",

}

Bhangui, P, Hakeem, AR, Di Maira, T, Rammohan, A, Sayed, BA, Soejima, Y, Shingina, A, Cheah, YL, McCluskey, S, Spiro, M, Ganesh, S, Rajalingam, R, Gupta, S, Findlay, J, Gupta, A, Chieh, AKW, Sakamoto, S, Xia, Q, Kim, KH, Polak, WG, Sapisochin, G, Soin, AS, Pomposelli, J, Vyas, M, Wiggins, C, Mas, V, Taner, T, Broering, D, Chen, CL, Terrault, N, Burra, P, Hirschfield, G, Ascher, N, Lerut, J, Rela, M, Heimbach, J, Selzner, N, Balci, D & Olthoff, K 2026, 'Living liver donor safety: Intraoperative considerations in living liver donation guidelines from the ILTS-iLDLT group consensus conference 2025', Liver Transplantation, vol. 32, no. 4. https://doi.org/10.1097/LVT.0000000000000800

TY - JOUR

T1 - Living liver donor safety

T2 - Intraoperative considerations in living liver donation guidelines from the ILTS-iLDLT group consensus conference 2025

AU - Bhangui, Prashant

AU - Hakeem, Abdul Rahman

AU - Di Maira, Tommaso

AU - Rammohan, Ashwin

AU - Sayed, Blayne Amir

AU - Soejima, Yuji

AU - Shingina, Alexandra

AU - Cheah, Yee Lee

AU - McCluskey, Stuart

AU - Spiro, Michael

AU - Ganesh, Swaytha

AU - Rajalingam, Rajesh

AU - Gupta, Subash

AU - Findlay, James

AU - Gupta, Amar

AU - Chieh, Alfred Kow Wei

AU - Sakamoto, Seisuko

AU - Xia, Qiang

AU - Kim, Ki Hun

AU - Polak, Wojciech G.

AU - Sapisochin, Gonzalo

AU - Soin, Arvinder Singh

AU - Pomposelli, James

AU - Vyas, Mary

AU - Wiggins, Chantal

AU - Mas, Valeria

AU - Taner, Timucin

AU - Broering, Dieter

AU - Chen, Chao Leng

AU - Terrault, Norah

AU - Burra, Patrizia

AU - Hirschfield, Gideon

AU - Ascher, Nancy

AU - Lerut, Jan

AU - Rela, Mohamed

AU - Heimbach, Julie

AU - Selzner, Nazia

AU - Balci, Deniz

AU - Olthoff, Kim

PY - 2026/4

Y1 - 2026/4

N2 - The success of living donor liver transplantation (LDLT) has bridged the growing gap between organ demand and availability in patients with liver failure or liver cancer. Safety of the living liver donor (LLD) is paramount, and astute intraoperative management plays a critical role in ensuring optimal outcomes in them. Given that intraoperative surgical and anesthesia practices vary widely across centers, the International Liver Transplantation Society (ILTS) and the International Living Donor Liver Transplantation Group (iLDLT Group) convened a global consensus conference in Toronto in March 2025 to develop guidelines for intraoperative management of the LLD. This manuscript details the recommendations on intraoperative considerations for the safety of LLD developed by Working Group II of the Consensus Scientific Committee, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for assessment of recommendations, and the Danish model of consensus. Working Group II focused on intraoperative monitoring, fluid and ventilation strategies, surgical techniques for vascular and biliary division, surgeon and center specific experience, and intraoperative crises planning. These guidelines aim to support both established and emerging LDLT teams to ensure high-quality and safe intraoperative care for the LLD.

AB - The success of living donor liver transplantation (LDLT) has bridged the growing gap between organ demand and availability in patients with liver failure or liver cancer. Safety of the living liver donor (LLD) is paramount, and astute intraoperative management plays a critical role in ensuring optimal outcomes in them. Given that intraoperative surgical and anesthesia practices vary widely across centers, the International Liver Transplantation Society (ILTS) and the International Living Donor Liver Transplantation Group (iLDLT Group) convened a global consensus conference in Toronto in March 2025 to develop guidelines for intraoperative management of the LLD. This manuscript details the recommendations on intraoperative considerations for the safety of LLD developed by Working Group II of the Consensus Scientific Committee, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for assessment of recommendations, and the Danish model of consensus. Working Group II focused on intraoperative monitoring, fluid and ventilation strategies, surgical techniques for vascular and biliary division, surgeon and center specific experience, and intraoperative crises planning. These guidelines aim to support both established and emerging LDLT teams to ensure high-quality and safe intraoperative care for the LLD.

UR - https://www.scopus.com/pages/publications/105029018071

U2 - 10.1097/LVT.0000000000000800

DO - 10.1097/LVT.0000000000000800

M3 - Review article

C2 - 41490582

AN - SCOPUS:105029018071

SN - 1527-6465

VL - 32

JO - Liver Transplantation

JF - Liver Transplantation

IS - 4

ER -

Living liver donor safety: Intraoperative considerations in living liver donation guidelines from the ILTS-iLDLT group consensus conference 2025

Abstract

Bibliographical note

UN SDGs

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