Three Decades of Living Liver Donor Outcomes: A National Cohort Analysis of Patterns in Mortality and Recovery

Living donor liver transplantation offers significant benefits to recipients, yet risks to donors remain incompletely characterized. We examined short- and intermediate-term outcomes associated with living liver donation using the Scientific Registry of Transplant Recipients. This retrospective cohort study included 8619 donors aged 18-65 years who donated between 1989 and 2023, of whom 8314 had follow-up data for secondary outcomes. Donors were categorized by era: early (1989-2006) and contemporary (2007-2023). Primary outcomes were 90-day and 2-year mortality; secondary outcomes were changes in physical capacity, functional status, and employment. Mean donor age was 36 years, and 53% were female. Eight donors (0.1%) died within 90 days and 18 (0.2%) within 2 years. Mortality was lower in the contemporary era at both 90 days (HR: 0.14, 95% CI: 0.03-0.70) and 2 years (HR: 0.06, 95% CI: 0.02-0.18). Reduced physical capacity at 6 months was more common among contemporary-era donors (aOR: 3.25, 95% CI: 1.32-8.00) and Hispanic donors (aOR: 2.07, 95% CI: 1.29-3.32). Reduced employment was more common among non-White donors at 6 months and 1 year (aOR: 2.04, 95% CI: 1.40-2.97 at 1 year), and among female donors at all timepoints (aOR: 1.71, 95% CI: 1.29-2.25 at 1 year). Living liver donor mortality has declined over the past three decades, and long-term physical impairments are uncommon. Reduced employment following donation is disproportionately reported by female and non-White donors. These findings provide a benchmark for center-level assessment of donor outcomes and may inform donor counseling that addresses occupational circumstances alongside surgical risk.