GILBERT syndrome in liver transplantation appears to be a benign finding that does not compromise graft function or patient outcomes, according to a systematic review and meta-analysis.
The inherited condition, a common cause of mild unconjugated hyperbilirubinemia, is present in around 4% of liver transplant donors and is typically asymptomatic.
There were no significant differences in donor postoperative complications, recipient outcomes, or one-year survival between grafts from donors with and without Gilbert syndrome.
Donor Prevalence Highlights a Clinically Relevant Finding
Across the included evidence base, Gilbert syndrome was identified in approximately 4% of liver transplant donors, while post-transplant occurrence in recipients was around 2%.
In recipients receiving grafts from known affected donors, donor-derived Gilbert syndrome was observed in 50% of cases, presenting as benign unconjugated hyperbilirubinemia. Importantly, these biochemical changes were not associated with adverse clinical outcomes, reinforcing the condition’s benign nature in the transplant setting.
Transplant Outcomes Remain Stable Across Studies
The systematic review included studies covering 424 donors and 419 recipients, alongside broader pooled datasets. A separate prevalence analysis incorporated 4,688 donors.
The analyses revealed no significant differences between donors with and without Gilbert syndrome in donor complication rates, hospital stay duration, or one-year recipient survival. Although recipients of grafts from affected donors showed higher peak bilirubin levels after surgery, this may be due to surgical stress, anaesthesia effects or ischaemia-reperfusion injury rather than impaired graft function.
Donor-Derived Gilbert Syndrome Reflects Liver-Specific Metabolism
Individual patient data from published cases demonstrated that post-transplant Gilbert syndrome typically presents as isolated unconjugated hyperbilirubinemia without graft dysfunction.
Overall postoperative complications were rare, occurring in fewer than 5% of cases, with no association with graft failure or mortality.
Clinical Implications for Transplant Assessment
The authors emphasise the importance of awareness of Gilbert syndrome, alongside biochemical assessment and, where appropriate, genetic testing to support accurate interpretation of function and reduce unnecessary investigations.
These findings add to growing evidence supporting the safety of liver transplantation using grafts from donors with Gilbert syndrome and could help reduce unnecessary donor exclusion and expand the available liver donor pool without compromising transplant safety.
Reference
Abdelwahab OA et al. A systematic review and meta-analysis on gilbert syndrome and liver transplantation: safety of donor grafts and risk of post-transplant donor-derived gilbert syndrome. J Liver Transpl. 2026;DOI:10.1016/j.liver.2026.100341.
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