Hepatologists ‘need to embrace’ living donor liver transplantation, expert says

BOSTON — In the Thomas E. Starzl Transplant Surgery State-of-the-Art Lecture presented at The Liver Meeting, Jean C. Emond, MD, vice chair and chief of liver transplantation at New York-Presbyterian/Columbia University Medical Center, discussed the current challenges faced in the acceptance of living donor liver transplantation. These include donor risks, concerns about patient variances and, perhaps, most importantly, the infrequency of clinician acceptance.

“We need the hepatologists to embrace [living donor liver transplantation],” Emond said. “We all need the multi-disciplinary team to make this work and manage the risks.”

Living donor liver transplantation has saved tens of thousands of lives worldwide and is the only option for liver transplantation patients in many countries, according to Emond’s presentation.

Yet, among the success stories are also tales of the potential hazards clinicians encounter in practice, which include differing liver sizes, imperfect measurements, flawed technical execution and the ever-present concern for an increase in medical errors.

“[The consideration of] recipient risk is demoralizing, so we are always searching for certainty, but variance is where we have to be realistic and … the only way to overcome variance is repetition,” Emond said during his lecture.

Emond stated that opposition to living donor liver transplantation is prevalent not only in hepatologists and surgeons, but also in the public. Still, he remained hopeful that, in the absence of other alternatives, technological and biological progress might overcome this opposition.

“I can’t say that living donor liver transplantation has achieved its promise in the US and Europe, even though I continue to believe it’s best for nearly every recipient candidate, but transplant teams aren’t quite ready for the most part,” Emond said. “I think we still remain complacent about wait-list mortality.

“I would contend that [living donor liver transplantation] will have a place until alternative donor sources are developed, which are not just around the corner,” Emond concluded. – by Melinda Stevens

For more information:

Emond JC. Thomas E. Starzl Transplant Surgery State-of-the-Art Lecture. Presented at: The Liver Meeting; Nov. 7-11, 2014; Boston.

Disclosure: Emond reports no financial relevant disclosures.