Living donor outcomes in an emerging living donor liver transplantation program: A single-center experience from Malaysia

doi:10.5500/wjt.122256

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Transplant. Sep 18, 2026; 16(3): 122256
Published online Sep 18, 2026. doi: 10.5500/wjt.122256

Living donor outcomes in an emerging living donor liver transplantation program: A single-center experience from Malaysia

Yeong Sing Lee, Shi Yu Cheng, Arbaie Hannis, Sanjiv Mahadeva, Kee Seang Chew, Peng Soon Koh

Yeong Sing Lee, Shi Yu Cheng, Arbaie Hannis, Peng Soon Koh, Hepatobiliary and Liver Transplantation Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 59100, Malaysia

Sanjiv Mahadeva, Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 59100, Malaysia

Kee Seang Chew, Paediatric Gastroenterology and Hepatology Unit, Department of Paediatrics, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 59100, Malaysia

Co-first authors: Yeong Sing Lee and Shi Yu Cheng.

Author contributions: Lee YS and Koh PS conceived and designed the study and developed the overall methodological and conceptual framework for evaluating living donor outcomes in an emerging living donor liver transplantation program; Lee YS and Hannis A were responsible for data curation, including the collection, verification, and organization of clinical and perioperative donor data; YS Lee and Cheng SY performed the formal data analysis, interpreted the findings, and contributed substantially to the statistical and clinical evaluation of donor outcomes as co-first authors; Lee YS, Cheng SY, Hannis A, Mahadeva S, Chew KS, and Koh PS participated in the investigation by contributing to donor evaluation, perioperative management, and program development, and by providing important intellectual input into the design, conduct, and interpretation of the study; Lee YS and Cheng SY drafted the original version of the manuscript; Koh PS provided overall supervision of the study, oversaw the liver transplantation program and its clinical governance, and guided the overall scientific direction and refinement of the manuscript; and all authors critically reviewed and revised the manuscript for important intellectual content and approved the final version for submission.

AI contribution statement: The authors take full responsibility and accountability for the content of this manuscript. ChatGPT (OpenAI) was used as an assistive tool for language editing, improving clarity, restructuring the manuscript, and refining the presentation of the text. All AI-assisted outputs were carefully reviewed, verified, and revised by the authors. AI tools were not used to generate original research data, perform statistical analyses, interpret study findings independently, or formulate the scientific conclusions.

Institutional review board statement: This study was approved by the Institutional Review Board of Universiti Malaya Medical Research.

Informed consent statement: This study did not involve prospective recruitment, interventional procedures, direct patient contact, or the collection of additional data from participants for research purposes. Accordingly, the requirement for informed consent for participation was waived owing to the retrospective, noninterventional nature of the study.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The technical appendix, statistical code, and dataset are not publicly available and are accessible only to the authors, as they contain confidential donor information and institutional identifiers. No additional data beyond those presented in the article are available.

Corresponding author: Peng Soon Koh, MBBS, MRCSEd, Associate Professor, Hepatobiliary and Liver Transplantation Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur 59100, Malaysia. kohps2000@yahoo.com

Received: April 15, 2026
Revised: July 13, 2026
Accepted: August 10, 2026
Published online: September 18, 2026
Processing time: 136 Days and 21.5 Hours

Abstract

BACKGROUND

Living donor liver transplantation (LDLT) has become an essential strategy to address the shortage of deceased donor organs in Malaysia. Universiti Malaya Medical Centre (UMMC), the second public institution in the country to establish a liver transplantation program, initiated its adult LDLT program in 2017 and became the first center in the country to successfully perform a living-related adult right lobe LDLT. However, data on donor outcomes from emerging LDLT programs remain limited.

AIM

To evaluate donor outcomes and perioperative results of an emerging LDLT program in Malaysia.

METHODS

This retrospective cohort study included all living donor hepatectomies performed at UMMC from January 2017 to June 2025. Data on donor selection, perioperative management, morbidity, and mortality were analyzed.

RESULTS

A total of 30 living donor hepatectomies were performed using right lobe, left lobe, and left lateral segment grafts. No donor mortality was observed. Complications included superficial wound infection (n = 4, 13.3%), anesthetic complications (n = 2, 6.7%), pulmonary atelectasis (n = 2, 6.7%), bile leak (n = 1, 3.3%), and gastrointestinal bleeding (n = 1, 3.3%). The median intraoperative blood loss was 500 mL (interquartile range: 400-800 mL), with a transfusion rate of 6.7%. The median length of hospital stay was 10 days. All donors achieved full functional recovery during follow-up.

CONCLUSION

As an emerging liver transplantation program, UMMC demonstrated favorable donor safety outcomes consistent with published reports from established LDLT centers. Continued refinement of surgical techniques, multidisciplinary perioperative care, and public awareness initiatives will be essential for the sustainable expansion of liver transplantation in Malaysia.

Keywords: Living donor liver transplantation; Donor outcomes; Hepatectomy; Perioperative complications; Malaysia

Core Tip: Universiti Malaya Medical Centre established Malaysia’s first structured adult living donor liver transplantation program in a public institution (2017) and has performed 30 living donor hepatectomies using right lobe, left lobe, and left lateral segment grafts. Donor safety is maintained through rigorous three-phase donor evaluation, multidisciplinary selection meetings, standardized open hepatectomy with routine intraoperative cholangiography, and protocol-driven perioperative care. Zero donor mortality, low-incident self-limiting complications, favorable intraoperative blood loss and length of hospital stay, and complete functional recovery indicate living donor liver transplantation can be safe in a low-volume, resource-constrained center when supported by robust clinical governance and evolving institutional expertise.