The absence of a cadaveric liver transplantation program in Egypt has led us to start the first living donor liver transplantation (LDLT) program in Egypt in August 2001. Since then we have performed more than 500 cases of LDLT in three transplant programs. This is mainly an adult program with only three paediatric cases and only three left lobe donations. the remaining 497 cases were right lobe donations of which two were for retransplants.

Donor safety has been of primary concern in our programs. Donors were 18 to 45 years of age with a mean of 30 and ABO-compatible. Liver biopsy was done routinely in all donors and 30% revealed abnormal findings in spite of normal tests stressing the importance of routine liver biopsy in donors.

There were no donor mortalities and donor complications were classified using the Clavien grading system with all complications within grades I and II. The residual liver volume was always kept at or above 35.
The mean age for recipients was 44 years, MELD 21. and BMI 26 with HCV constituting 95% of the cases.

Associated Hepatocellular carcinoma (HCC) has been the indication in 19% of cases with 98% of those within the Milan criteria.

Biliary complications have been an initial challenge being a cause of mortality in 0.5% and morbidity in > 10% of cases in the initial 130 cases analysed. Modification of the surgical technkque and selection criteria has eliminated the mortality from biliary complications in LDLT.