Abstract
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.