Living Donor Liver Transplantation (original) (raw)

Liver Transplants from Living Donors

Apollo Medicine, 2006

In the west majority liver transplantation is from deceased donors. In the Far East most liver transplant is actually done from living related donors. In the past, when experience with hepatectomy was limited, liver transplantation did not progress because of lack of cadaveric donors. With hepatectomy becoming a safe operation, liver transplant from living donors is a good alternative. Although there is a risk to donor, LRLT has certain advantages over DDLT in our country such as optimum patient preparation prior to surgery, allows use of cadaveric organs when available, for patients with primary liver turnover, for adoptive transfer of immunity in patients with hepatitis B related cirrhosis and in acute liver failure. LRLT should be promoted and safeguards built in for donor safety.

Live Donor Adult Liver Transplantation Using Right Lobe Grafts

Archives of Surgery, 2001

single team performed 15 LDALT procedures with 2 simultaneous living donor kidney transplants. During this period, 66 potential donors were screened and evaluated. Interventions: Potential donors were evaluated with 3-dimensional helical computed tomographic scan, including volume renderings for hepatic lobar volume, vascular anatomy, virtual resection planes, and morphologic features. Suitable donors undergo complete medical and psychiatric evaluation and preoperative arteriography. Main Outcome Measures: Donor demographics, evaluation data, operative data, hospital length of stay, and morbidity. Results: A total of 38 men (58%) and 28 women (42%) were evaluated with 15 donors participating in LDALT. Two additional donors provided kidney grafts for simultaneous transplantation at the time of LDALT. Thirtytwo donors (48%) were rejected for either donor or recipient reasons, and 10 patients (15%) elected not to participate after initial screening. Three-dimensional volume renderings by helical computed tomographic scan predicted right lobe liver volume within 92% of actual graft volume. Donor morbidity, including all complications, was 67% with no mortality. Residual liver regenerated to approximately 70% of initial volume within 1 week and 80% within 1 month after surgery. Conclusions: Donor evaluation is an important component of LDALT. Significant donor morbidity is encountered even with careful selection. To minimize donor morbidity, groups considering initiating living donor programs should have expertise in hepatic resection and vena cava preservation using the "piggyback" technique during liver transplantation.

Right Living Donor Liver Transplantation: An Option for Adult Patients

Annals of Surgery, 2003

Objective: To present an institutional experience with the use of right liver grafts in adult patients and to assess the practicability and efficacy of this procedure by analyzing the results. Summary Background Data: Living donor liver transplantation (LDLT) for the pediatric population has gained worldwide acceptance. In the past few years, LDLT has also become feasible for adult patients due to technical evolution in hepatobiliary surgery and increased experience with reduced-size and split-liver transplants. Nevertheless, some graft losses remain unexplained and are possibly due to unrecognized venous outflow problems. Methods: From April 1998 to September 2002, we performed 74 right LDLTs (segments 5-8). The 74 donors were selected from 474 candidates according to standard protocol. The median age of the donors was 35 years (range 18-58 years) and 51 years (range 18-64 years) in recipients. Standard and extended indications for transplantation were considered. Over the period reported, technical modifications in the bile duct anastomosis (duct-to-duct, end-to-end, or end-to-side) and a new graft implantation technique that provides maximized venous outflow, leading to outcome improvement, were developed. Results: 64.9% of patients had liver cirrhosis and 35.1% had malignancy. While 44 donors (59.5%) presented an uneventful postoperative course, 27% minor (pleural effusion, pneumonia, venous thrombosis, wound infection, incisional hernia) and 13.5% major (biliary leakage, death of a donor due to unrecognized hereditary liver disease, and consecutive liver insufficiency) complications were documented. In recipients, 23% biliary complications and 6.8% hepatic artery thrombosis occurred. The overall patient and graft survival rate after 1 year was 79.4% and 75.3%,

Living donor liver transplantation: techniques and results

Current Opinion in Organ Transplantation, 2001

Living donor liver transplantation (LDLT) has been practiced for more than a decade, but until recently only the pediatric population realized the benefit of this large pool of organs. Right lobe donor resection has made it possible to routinely offer this alternative to adults, and the overwhelming demand for organs has motivated a substantial number of transplant centers to become involved with adult-to-adult LDLT. A reasonable level of donor safety has been demonstrated, and recipient results have been encouraging thus far. A wealth of experience has accumulated during the past few years, making it possible to begin to focus on the nuances specific to right lobe grafting. Efforts toward achieving optimal results have concentrated on the management of the hepatic veins and bile ducts, and the donor and recipient surgeries are evolving with these variables in mind. Other donor resections have been reported but have not gained widespread acceptance. Left sided liver resections and transplants are still routinely performed for children, and the surgical techniques have continued to evolve but not at the same pace. This review highlights the technical advances and considerations that have been reported and discussed during the past year, with particular emphasis on those pertinent to standard right lobe LDLT.

Living-donor liver transplantation: evaluation of donor and recipient

Nephrology Dialysis Transplantation, 2004

Living-donor liver transplantation (LDLT) in adults has been expanded after becoming the standard for children in many transplant centres. Advantages of LDLT include thorough donor screening, optimization of timing for transplantation and minimal cold ischaemia time. However, the risk of donor morbidity and mortality must be considered. The preoperative evaluation of the donor typically is performed in consecutive stages. Specific donor considerations in LDLT are thrombosis and embolism, hepatic mass and hepatic steatosis. After complete evaluation, only a small proportion of potential donors are satisfactory candidates. The evaluation protocol for LDLT recipients in most centres is not different from that of cadaveric transplantation. More experience and the development of specific selection and evaluation criteria will further increase the benefit for the recipient and decrease the risk of the donor.

Living-Donor Liver Transplantation: Results of a Single Center

Transplantation Proceedings, 2007

In the absence of cadaveric donor liver transplantation, living-donor liver transplantation (LDLT) is an alternative option for patients with end-stage liver disease. The objective of this study was to evaluate the outcome of LDLT at a single medical center in Turkey. We retrospectively analyzed the results of 101 LDLTs in 99 recipients with end-stage liver disease. We transplanted 49 right liver lobes, 16 left lobes, and 36 hepatic segments II and III. Most donors (46%) were parents of the recipients. Seventeen recipients had concomitant hepatocellular carcinoma and cirrhosis. Retransplantation was performed in two recipients. Ten hepatic arterial thromboses, 1 hepatic arterial bleeding, and 12 biliary leaks occurred in the early postoperative period. Most complications were treated with interventional techniques. Three hepatic vein stenoses, three portal vein stenoses, one hepatic arterial stenosis, and six biliary stenoses developed during the late postoperative period. Recipients with those complications were treated with interventional techniques. Mean follow-up was 14.2 Ϯ 10.9 months. During that time, no tumor recurrence was detected in any recipient with hepatocellular carcinoma. Twenty-two recipients died during the follow-up. At this time, the remaining 77 recipients (77%) are alive, exhibiting good graft function. In general, complication rates are slightly higher after LDLT than after cadaveric liver transplantation. However, most complications can be treated with interventional techniques. LDLT continues to be a life-saving option in countries without satisfactory cadaveric donation rates.