Long-term hepatic and metabolic outcomes in living liver donors
- Author:
Byeong Geun SONG
1
Author Information
- Publication Type:Review Article
- From: Annals of Liver Transplantation 2026;6(1):8-16
- CountryRepublic of Korea
- Language:English
- Abstract: Living donor liver transplantation (LDLT) has become a critical strategy for addressing the global organ shortage, particularly in East Asia. While perioperative donor safety has been well established, the long-term hepatic and metabolic consequences of donor hepatectomy have only recently come under systematic investigation.A landmark Korean population-based study of 12,372 donors revealed elevated incidence rates of liver failure, diabetes, hypertension, cardiovascular events, and overall mortality compared with matched healthy controls. Post-donation steatotic liver disease develops progressively, reaching a cumulative incidence of approximately 28% at 15 years, with donation for a pediatric recipient, pre-donation body mass index, and male sex as independent predictors. Liver regeneration after right hepatectomy is generally robust, with most donors achieving 80%–90% of their original liver volume by 6–12 months, though factors such as donor age, portal hemodynamics, and body composition influence the regenerative response. This review synthesizes the current evidence on long-term hepatic regeneration, liver function, post-donation steatosis, and cardiometabolic morbidity in living liver donors. We discuss identifiable risk factors for adverse outcomes and propose a structured framework for lifelong donor surveillance. These data underscore the ethical obligation of transplant programs to ensure comprehensive, sustained follow-up for all living liver donors.
