# Developing an Adult Living Donor Liver Transplant Program in Western Europe: The Rotterdam Experience

## TL;DR

This paper describes the successful setup of an adult living donor liver transplant program in Rotterdam, showing high survival rates and lessons learned.

## Contribution

The paper provides a detailed framework for establishing a LDLT program in Western Europe with real-world outcomes.

## Key findings

- 54 LDLT operations were performed with 97% patient and graft survival.
- Donor complications were low with no donor mortality reported.
- 41% of patients were transplanted for primary sclerosing cholangitis.

## Abstract

Liver transplantation (LT) is curative for end stage liver disease. Expanding LT indications with limited deceased donor grafts has created organ shortages. Living donor liver transplant (LDLT) increases available organs. In 2019, we restarted our adult LDLT program. We describe our steps to create a successful LDLT program, and our outcomes. Critical steps of program development included market analysis, creation of protocols based on best care practices and a rigorous education program. Patients and donors were then actively recruited for LDLT. Outcomes were measured as morbidity (≥3 on the Clavien-Dindo grading system) and mortality. Between January 2019 and August 2024, 54 LDLT were performed. 2 (3%) donors experienced grade 3A and 7 (12%) donors experience grade 3B complications. There was no donor mortality. 22 (41%) patients were transplanted for PSC, the average MELD score was 13 (6–32). 35 (65%) patients had Roux-en-Y reconstructions. 25 (46%) complications were experienced in 22 (40%) patients, there were 2 recipient deaths. Patient and graft survival after LDLT was 97% and 97%, respectively. This paper reported the successful establishment of a LDLT program in the Netherlands. Establishing a LDLT program brings its own unique challenges, with careful planning and persistence, these challenges can be overcome.

Flowchart detailing the development of a successful adult living donor liver transplant (LDLT) program in Rotterdam, Western Europe. Steps include program development, patient recruitment, performing fifty-four LDLT operations from 2019 to 2024, achieving ninety-seven percent patient and graft survival. The cycle starts in 2019 with the program's restart. Logos of ESOT and Transplant International are present. Reference to a publication by Chorley et al. in “Transplant International” 2025 is included.