Enhanced Recovery Protocols Promote Donor Recovery in Living-Donor Liver Transplantation

For more than two decades, UPMC has been a global leader in living-donor liver transplantation. A new analysis published by UPMC physicians and researchers, presented by Swaytha Ganesh, MD, Medical Director, UPMC Living Donor Program, at the 2025 World Transplant Congress highlights how enhanced recovery after surgery (ERAS) protocols in living-donor liver transplant patients have promoted quicker recovery for donors after hepatectomy, offering compelling evidence for a new standard of perioperative living organ donor care.

ERAS refers to a set of protocols that optimize pre-, intra-, and postoperative care to reduce complications and improve patient recovery times.

Between 2001 and June 2024, UPMC surgeons performed more than 1,000 living donor hepatectomies. The average donor age was 36.8 years old, with a majority undergoing right lobe donation (78%). Since the introduction of ERAS protocols in 2016, nearly 650 donors have benefited from structured preoperative counseling, optimized nutrition, multimodal anesthetic and analgesic regiments emphasizing non-opioid pain management, and early mobilization.

Average hospital stay decreased from 7.4 days in the early 2000s to 4.7 days in the most recent group of donors (2021-June 2024). Three-month reoperation declined after ERAS implementation, from 12% in 2011–2015 to 8.3% in 2021–2024. Biliary complications remained uncommon, with leaks in just 1.3% of donors and strictures in 0.4%. Hernias continue to represent the most frequent indication for reoperation. Across all 1,009 cases, there was no donor mortality within the first year.

Equally important are the patient-centered outcomes. Post-ERAS donors demonstrated faster return of bowel function, lower pain scores, reduced opioid consumption, and improved quality-of-life metrics compared with pre-ERAS donors.

UPMC’s sustained growth in living-donor liver transplantation, paired with continuous innovation in donor care pathways, demonstrates the commitment to advancing both technical excellence and donor well-being.

Over One Thousand Consecutive Living Donor Hepatectomies over 24 Years at a Single Institution- The Impact of ERAS Protocols on Donor Recovery
Gunabushanam V., Ganesh S., Molinari M., Cruz Jr R., Tevar A., Sethi V., Ganoza A., Hughes C., Humar A.

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