Critical Role for Living-Donor Liver Transplantation in a Changing Organ Landscape: Insights on National Trends from the NALLDIG Consortium.

Despite offering excellent outcomes and improved transplant access, living-donor liver transplantation (LDLT) has persistently represented a small minority of total liver transplant volume in the United States. Conversely, the use of advanced preservation (AP) technology and expansion of donation after circulatory death has been explosive. The impact of these trends on the future of LDLT practice in the US remains uncertain. Prior assessments have varied from considering LDLT and AP complimentary avenues to LT, to suggesting that increased deceased donor availability may render LDLT diminishingly relevant. In this viewpoint, the members of the North American Living Liver Donor Innovation Group, a consortium representing 37 LDLT-performing transplant centers, review key trends and contextualize heterogenous changes in LDLT practice. The authors argue that LDLT will continue to maintain relevance in the face of AP-driven increased deceased donor availability and argue that LDLT availability and expertise be preserved and expanded in the post-AP era.