Lecture : Importance: Although live liver donors are generally in healthy status, the long-term mortality of them is not reported in a large donor registry.
Objective: To evaluate the long-term mortality of Korean live liver donors using data from a national donor registry and to compare the mortality with controls.
Design: Live liver donors were drawn from a mandated national registry of 10,116 live liver donors in Korea between 2000 and 2015. Matched controls were selected from the Korean National Health Insurance System ? National Sample Cohort (NHIS-NSC).
Setting: Mandated national registry-based study.
Participants: Median (range) follow-up of liver donors was 5.7 (0-15.9) years. Donors were 1:3 individually matched to controls which were drawn from the NHIS-NSC with (Control 1) and without (Control 2) contraindications for liver donation by sex and 5-year age group (donor, n=7,538; Control 1, n=28,248; Control 2, n=28,248).
Exposure: Liver donation
Main Outcome and Measure: Overall mortality

Results: Fifty-three deaths occurred after donation. Ten-year cumulative mortality of live liver donors was 0.9%. The most common cause of death was suicide (n=19). In matched control analysis, overall risk of death was significantly lower in donors than in Control 1 (P<0.001), but higher than in Control 2 (P<0.001). Risk of death from suicide in donors was similar with Control 1 (P=0.923), but higher than in Control 2 (P=0.001). Risk of death from cancer was lower in donors than in Control 1 (P=0.03), but higher than in Control 2 (P=0.004).

Conclusions and Relevance: Liver donors are at increased long-term mortality risk than healthy controls. Long-term careful surveillance and follow-up including psychosocial support are needed for live liver donors.