ILTS–iLDLT Group consensus guidelines: Intraoperative management for living liver donor safety

Consensus guidelines from the International Liver Transplantation Society (ILTS) and International Living Donor Liver Transplantation (iLDLT) Group on the intraoperative management of donors in living donor liver transplantation (LDLT) were published in Liver Transplantation by Bhangui et al. The guidelines outline 16 recommendations to optimize the safety of living liver donors (LLDs). 

Key data: Recommendations include fluid-restrictive parenchymal transection with low central venous pressure (CVP), supported by dynamic hemodynamic monitoring, lung-protective ventilation (LPV), and multimodal analgesia, with no preferred locoregional analgesic technique. Surgical teams should have appropriate experience, with proctorship or mentorship during early program adoption and continuous donor/recipient outcome monitoring. For minimally invasive donor hepatectomy (MIDH), stringent donor and graft selection criteria are recommended, alongside a low threshold for conversion to open surgery, imaging-guided bile duct division, and the implementation of contingency plans and formal crisis-reporting pathways. 

Key learning: LLD safety during transplantation requires standardized intraoperative management incorporating dynamic monitoring, experienced surgical teams, careful donor selection, and structured contingency planning.