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Live Donor Liver Transplant

  • Reference work entry
  • First Online:
Contemporary Liver Transplantation

Part of the book series: Organ and Tissue Transplantation ((OTT))

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Abstract

Adult living donor liver transplantation (LDLT) has become a life-saving procedure due to the limited availability of deceased donor organs in many parts of the world. It continues to be a technically challenging procedure and involves inherently complex ethical issues. Donor safety remains the priority; however, a successful recipient outcome after LDLT is also paramount.

The safety margin is small for both recipient and donor, each case should be tailored to the patients, and every step of the procedure must be planned and performed meticulously.

Over the last two decades, many of the issues related to the technical design of adult LDLT procedures have been solved; there does however remain room for further innovation. A better understanding of the complex surgical anatomy and physiologic differences of adult LDLT helps avoid small-for-size (SFS) graft syndrome, graft congestion from outflow obstruction, and graft hypoperfusion from portal flow steal. Size limitations of partial grafts and donor safety issues can be overcome with dual grafts and modified right lobe (MRL) grafts that preserve the donor’s middle hepatic vein trunk.

LDLT is a more complex operation than DDLT, requiring delicate dissection around the hilum as high as possible in order to obtain maximum length of individual structures, allowing for implantation of the smaller-sized living partial liver graft vessels. For technically successful LDLT, the following four conditions should be satisfied: adequate graft volume to avoid small-for-size syndrome, good outflow to avoid congestion, adequate portal inflow to enhance graft regeneration, and secure bile duct anastomosis to avoid biliary leak. However, the risk of surgical complications still remains higher when compared to DDLT. Crucial to maintaining good outcomes following LDLT is a robust multidisciplinary approach with surgical, radiological, and medical teams and a wide range of ancillary services.

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Abbreviations

3D CT:

Three-dimensional computed tomography

AS:

Anterior sector

BD:

Bile duct

BS:

Biliary stricture

DDLT:

Deceased donor liver transplantation

ERL:

Extended right lobe graft

GRWR:

Graft-to-recipient weight ratio

GSV:

Great saphenous vein

HA:

Hepatic artery

HPCS:

Hemiportocaval shunt

HTK:

Histidine-tryptophan-ketoglutarate

HV:

Hepatic vein

IOCP:

Intraoperative cineportography

IOUS:

Intraoperative Doppler ultrasound

IRHV:

Inferior right hepatic vein

IVC:

Inferior vena cava

LDLT:

Living donor liver transplantation

LHA:

Left hepatic artery

LL:

Left liver

MELD:

Model for end-stage liver disease

MHV:

Middle hepatic vein

MRI:

Magnetic resonance imaging

MRL:

Modified right lobe

PTFE:

Polytetrafluoroethylene

PV:

Portal vein

RHA:

Right hepatic artery

RL:

Right liver

SFS:

Small-for-size

SHV:

Short hepatic vein

UW:

University of Wisconsin

V5:

Middle hepatic vein tributaries of segment 5

V8:

Middle hepatic vein tributaries of segment 8

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Authors and Affiliations

  1. Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, 138-736, Seoul, South Korea

    Sung-Gyu Lee & Deok-Bog Moon

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  1. Sung-Gyu Lee
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  2. Deok-Bog Moon
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Correspondence to Sung-Gyu Lee .

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Editors and Affiliations

  1. Nicoletti Family Professor of Transplant Surgery, Director, Jefferson Transplant Institute, Director, Division of Transplantation, Surgical Director, Kimmel Cancer Center – Jefferson Liver Tumor Center, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA

    Cataldo Doria

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Lee, SG., Moon, DB. (2017). Live Donor Liver Transplant. In: Doria, C. (eds) Contemporary Liver Transplantation. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-07209-8_5

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  • DOI: https://doi.org/10.1007/978-3-319-07209-8_5

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-07209-8

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