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Langenbeck's Archives of Surgery

, Volume 392, Issue 6, pp 657–662 | Cite as

Adult living donor liver transplantation: living donation of the right liver lobe

  • J. MittlerEmail author
  • A. Pascher
  • S. Jonas
  • J. Pratschke
  • U. P. Neumann
  • J. M. Langrehr
  • P. Neuhaus
Current Concepts in Clinical Surgery

Abstract

Background

Adult living donor liver transplantation (LDLT) has become a routine treatment option for patients waiting for liver transplantation. In European and North American countries, LDLT for adult recipients is mainly performed with right lobe grafts. Indications, when compared to deceased donor liver transplantation, are controversial.

Materials and methods

In our institution, patients suffering from hepatocellular carcinoma in cirrhosis, non-resectable hilar cholangiocarcinoma, viral hepatitis associated cirrhosis, as well as cholestatic liver and biliary disease are considered good candidates for LDLT.

Results

In this overview, donor evaluation, graft selection, and the donor operation with special regard to operative techniques and strategies are discussed. For visualization, a 5-min video sequence of the standard donor operation as performed in our institution is attached.

Conclusion

Given the ongoing shortage of donor organs, adult LDLT has become a routine treatment option for patients waiting for liver transplantation. The associated inevitable risk for the healthy donor, however, remains ethically controversial.

Keywords

Liver transplantation Living donation Evaluation Indications Operative strategy 

Supplementary material

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References

  1. 1.
    Cherqui D, Edmond JC, Pietrabissa A et al (1990) Segmental liver transplantation from living donors. Report of the technique and preliminary results in dogs. HPB Surg 2:189PubMedCrossRefGoogle Scholar
  2. 2.
    Strong RW, Lynch SV, Ong TH et al (1990) Successful liver transplantation from a living donor to her son. N Eng J Med 322:1505–1507CrossRefGoogle Scholar
  3. 3.
    Hashikura Y, Makuuchi M, Kawasaki S et al (1994) Successful living-related partial liver transplantation to an adult patient. Lancet 343:1233–1234PubMedCrossRefGoogle Scholar
  4. 4.
    Yamaoka Y, Washida M, Honda K et al (1994) Liver transplantation using a right lobe graft from a living related donor. Transplantation 57:1127–1130PubMedCrossRefGoogle Scholar
  5. 5.
    Lo CM, Fans ST, Liu CL et al (1997) Extending the limit on the size of adult recipient in living donor liver transplantation using extended right lobe graft. Transplantation 63:1524–1528PubMedCrossRefGoogle Scholar
  6. 6.
    Fan ST (2006) Live donor liver transplantation in adults. Transplantation 82(6):723–732PubMedCrossRefGoogle Scholar
  7. 7.
    Zieniewicz K, Skwarek A, Nyckowski P et al (2003) Comparison of the results of liver transplantation for elective versus urgent indications. Transplant Proc 35:2262–2264PubMedCrossRefGoogle Scholar
  8. 8.
    Uemoto S, Inomata Y, Sakurai T et al (2000) Living donor liver transplantation for fulminant hepatic failure. Transplantation 70:152–157PubMedGoogle Scholar
  9. 9.
    Abt PL, Mange KC, Olthoff KM et al (2004) Allograft survival following adult-to-adult living donor liver transplantation. Am J Transplant 4:1302–1307PubMedCrossRefGoogle Scholar
  10. 10.
    Liu CL, Fan ST, Lo CM et al (2002) Right-lobe live donor liver transplantation improves survival of patients with acute liver failure. Br J Surg 89:317–322PubMedCrossRefGoogle Scholar
  11. 11.
    Liu CL, Fan ST, Lo CM et al (2003) Live-donor liver transplantation for acute-on-chronic hepatitis B liver failure. Transplantation 76:1174–1179PubMedCrossRefGoogle Scholar
  12. 12.
    Garcia-Retortillo M, Forns X, Llovet JM et al (2004) Hepatitis C recurrence is more severe after living donor compared to cadaveric liver transplantation. Hepatology 40:699–707PubMedCrossRefGoogle Scholar
  13. 13.
    Russo MW, Shresta R (2004) Is severe recurrent hepatitis C more common after adult living donor liver transplantation? Hepatology 40:524–526PubMedCrossRefGoogle Scholar
  14. 14.
    Shiffman ML, Stravitz RT, Contos MJ et al (2004) Histologic recurrence of chronic hepatitis C virus in patients after living donor and deceased donor liver transplantation. Liver Transpl 10:1248–1255PubMedCrossRefGoogle Scholar
  15. 15.
    Schmeding M, Neumann UP, Puhl G et al (2007) Hepatitis-C recurrence and fibrosis progression are not increased after living donor liver transplantation—a single center study of 289 patients. Liver Transpl (in press)Google Scholar
  16. 16.
    Todo S, Furukawa H (2004) Living donor liver transplantation for adult patients with hepatocellular carcinoma: experience in Japan. Ann Surg 240:451–461PubMedCrossRefGoogle Scholar
  17. 17.
    Jonas S, Mittler J, Pascher A et al (2007) Living donor liver transplantation of the right lobe for hepatocellular carcinoma in cirrhosis. (in press)Google Scholar
  18. 18.
    Gondolesi GE, Roayaie S, Munoz L, et al (2004) Adult living donor liver transplantation for patients with hepatocellular carcinoma: extending UNOS priority criteria. Ann Surg 239:142–149PubMedCrossRefGoogle Scholar
  19. 19.
    Broelsch CE, Frilling A, Malago M (2005) Should we expand the criteria for liver transplantation for hepatocellular carcinoma—yes, of course! J Hepatol 43:569–573PubMedCrossRefGoogle Scholar
  20. 20.
    Jonas S, Mittler J, Pascher A et al (2005) Extended indications in living-donor liver transplantation: bile-duct cancer. Transplantation 80(Suppl 1):S101–S104PubMedCrossRefGoogle Scholar
  21. 21.
    Neuhaus P (2005) Live donor/split liver grafts for adult recipients: when should we use them? Liver Transpl 11(Suppl 1):S6–S9PubMedCrossRefGoogle Scholar
  22. 22.
    Pascher A, Sauer IM, Walter M et al (2002) Donor evaluation, donor risks, donor outcome, and donor quality of life in adult-to-adult living donor liver transplantation. Liver Transpl 8:829–837PubMedCrossRefGoogle Scholar
  23. 23.
    Chisuwa H, Hashikura Y, Mita A et al (2003) Living liver donation: preoperative assessment, anatomic considerations and long-term outcome. Transplantation 75:1670–1676PubMedCrossRefGoogle Scholar
  24. 24.
    Valentin-Gamazo C, Malago M, Karliova M et al (2004) Experience after the evaluation of 700 potential donors for living donor liver transplantation in a single center. Liver Transpl 10(9):1087–1096PubMedCrossRefGoogle Scholar
  25. 25.
    Fan ST, Lo CM, Liu CL et al (2000) Safety of donors in live donor liver transplantation using right lobe grafts. Arch Surg 135:336–340PubMedCrossRefGoogle Scholar
  26. 26.
    Kiuchi T, Tanaka K, Ito T et al (2003) Small-for-size graft in living donor liver transplantation: how far should we go? Liver Transpl 9(Suppl 1):S29–S35PubMedCrossRefGoogle Scholar
  27. 27.
    Lemke AJ, Brinkmann MJ, Pascher A, Steinmueller T, Settmacher U, Neuhaus P, Felix R (2003) Accuracy of the CT-estimated weight of the right hepatic lobe prior to living related liver donation (LRLD) for predicting the intraoperatively measured weight of the graft. Rofo 175(9):1232–1238 (Sep)PubMedGoogle Scholar
  28. 28.
    Lo CM, Fan ST, Liu CL et al (1999) Minimum graft size for successful living donor liver transplantation. Transplantation 68:1112–1116PubMedCrossRefGoogle Scholar
  29. 29.
    Marcos A, Fisher RA, Ham JM et al (2000) Liver regeneration and function in donor and recipient after right lobe adult to adult living donor liver transplantation. Transplantation 69:1375–1379PubMedCrossRefGoogle Scholar
  30. 30.
    Varotti G, Gondolesi GE, Goldmann G et al (2004) Anatomic variations in right liver living donors. J Am Coll Surg 198:577–582PubMedCrossRefGoogle Scholar
  31. 31.
    Michels NA (1940) Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 112:337–347CrossRefGoogle Scholar
  32. 32.
    Hwang S, Lee SG, Lee YJ et al (2006) Lessons learned from 1,000 living donor liver transplantations in a single center: how to make living donations safe. Liver Transpl 12:920–927PubMedCrossRefGoogle Scholar
  33. 33.
    Fan ST, Lo CM, Liu CL et al (2003) Safety and necessity of including the middle hepatic vein in the right lobe graft in adult to adult live donor liver transplantation. Ann Surg 238:137–148PubMedCrossRefGoogle Scholar
  34. 34.
    Yamamoto H, Maetani Y, Kiuchi T et al (2003) Background and clinical impact of tissue congestion in right-lobe living donor liver grafts: a magnetic resonance imaging study. Transplantation 76:164–169PubMedCrossRefGoogle Scholar
  35. 35.
    Kim BS, Kim TK, Kim JS et al (2004) Hepatic venous congestion after living donor liver transplantation with right lobe graft: two-phase CT-findings. Radiology 232:173PubMedCrossRefGoogle Scholar
  36. 36.
    Kaneko T, Sugimoto H, Hirota M et al (2005) Intrahepatic venous anastomosis formation of the right liver in living donor liver transplantation: evaluations by Doppler ultrasonography and pulse-inversion ultrasonography with Levovist. Surgery 138:21–27PubMedCrossRefGoogle Scholar
  37. 37.
    Ito T, Kiuchi T, Yamamoto H et al (2004) Efficacy of anterior segment drainage reconstruction in right lobe liver grafts from living donors. Transplantation 77:865–868PubMedCrossRefGoogle Scholar
  38. 38.
    Akamatsu N, Sugawara Y, Kaneko J et al (2003) Effects of middle hepatic vein reconstruction on right liver graft regeneration. Transplantation 76:832–837PubMedCrossRefGoogle Scholar
  39. 39.
    Cattral MS, Molinari M, Vollmer CM Jr et al (2004) Living donor right hepatectomy with or without inclusion of middle hepatic vein: comparison of morbidity and outcome in 56 patients. Am J Transplant 4:751–757PubMedCrossRefGoogle Scholar
  40. 40.
    Scatton O, Belghiti J, Dondero F et al (2004) Harvesting the middle hepatic vein with a right hepatectomy does not increase the risk for the donor. Liver Transpl 10:71–76PubMedCrossRefGoogle Scholar
  41. 41.
    Hata S, Sugawara Y, Kishi Y et al (2004) Volume regeneration after right liver donation. Liver Transpl 10:65–70PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • J. Mittler
    • 1
    Email author
  • A. Pascher
    • 1
  • S. Jonas
    • 1
  • J. Pratschke
    • 1
  • U. P. Neumann
    • 1
  • J. M. Langrehr
    • 1
  • P. Neuhaus
    • 1
  1. 1.Department of General, Visceral and Transplant SurgeryCharité-Campus Virchow Klinikum, Universitätsmedizin BerlinBerlinGermany

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