Journal of Hepato-Biliary-Pancreatic Surgery

, Volume 13, Issue 5, pp 370–377 | Cite as

Living-donor liver transplantation: an overview

  • Russell W. Strong


It has been 16 years since the first successful living-donor liver transplant was performed from a parent to a child. The overall recipient and graft survival, together with a low morbidity and mortality in donors, have resulted in the widespread acceptance of the procedure by both the transplant community and the public at large. Adult-to-adult living-donor liver transplantation has been evolving over the past decade. Despite living-donor transplant patients being better-risk candidates than those who receive a graft from a deceased donor, and well-established and experienced units achieving satisfactory results, overall recipient and graft survival recorder by registries can only be described as suboptimal. This, combined with the high morbidity and not-insignificant mortality amongst donors makes expansion of adult-to-adult liver transplantation hard to justify on a risk-benefit analysis.

Key words

Liver transplantation Living donor Recipient outcome Donor morbidity Mortality Ethical issues 


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  1. 1.
    Strong, R, Lynch, S, Ong, T, Matsunami, H, Koido, Y, Balderson, G 1990Successful liver transplantation from a living donor to her sonN Engl J Med32215057PubMedCrossRefGoogle Scholar
  2. 2.
    Strong, R, Ong, T, Pillay, P, Wall, D, Balderson, G, Lynch, S 1988A new method of segmental orthotopic liver transplantation in childrenSurgery1041048PubMedGoogle Scholar
  3. 3.
    Nagasue, N, Kohno, H, Matsuo, S, Yamanoi, A, Uchida, M, Takemoto, Y,  et al. 1992Segmental (partial) liver transplantation from a living donorTranspl Proc2419589Google Scholar
  4. 4.
    Broelsch, C, Emond, J, Whitington, P, Thistlethwaite, , Baker, A, Lichtor, J 1990Application of reduced-size liver transplants as split grafts, auxiliary orthotopic grafts and living related segmental transplantsAnn Surg21236875PubMedGoogle Scholar
  5. 5.
    Hashikura, Y, Makuuchi, M, Kawasaki, S, Matsunami, H, Ikegami, T, Nakazawa, Y,  et al. 1994Successful living related partial liver transplantation to an adult patientLancet34312334PubMedCrossRefGoogle Scholar
  6. 6.
    Emond, J, Renz, J, Ferrell, L, Rosenthal, P, Lim, R, Roberts, J,  et al. 1996Functional analysis of grafts from living donors: implications for the treatment of older recipientsAnn Surg22454454PubMedCrossRefGoogle Scholar
  7. 7.
    Miyagawa, S, Hashikura, Y, Miwa, S, Ikegami, T, Urata, K, Terada, M,  et al. 1998Concomitant caudate lobe resection as an option for donor hepatectomy in adult living related liver transplantationTransplantation666613PubMedCrossRefGoogle Scholar
  8. 8.
    Yamaoka, Y, Washida, M, Honda, K, Tanaka, K, Mori, K, Shimahara, Y,  et al. 1994Liver transplantation using a right lobe graft from a living related donorTransplantation57112730PubMedGoogle Scholar
  9. 9.
    Lo, CM, Fan, ST, Liu, CL, Wei, WL, Lo, RJ, Lai, CL,  et al. 1997Adult to adult living donor liver transplantation using extended right lobe graftsAnn Surg2262619PubMedCrossRefGoogle Scholar
  10. 10.
    Gridelli, B, Spada, M, Petz, W, Bertani, A, Luciassetti, A, Colledan, M,  et al. 2003Split-liver transplantation eliminates the need for living donor liver transplantation in children with end-stage cholestatic liver diseaseTransplantation751197203PubMedCrossRefGoogle Scholar
  11. 11.
    Mori, K, Nagata, I, Yamagata, S, Sasaki, H, Nishizawa, F, Takada, Y,  et al. 1992The introduction of microvascular surgery to hepatic artery reconstruction in living donor liver transplantation — its advantages compared with conventional proceduresTransplantation542638PubMedGoogle Scholar
  12. 12.
    Hashikura, Y, Kawasaki, S, Okumura, N, Ishikawa, S, Matsumami, H, Ikegami, T,  et al. 1995Prevention of hepatic artery thrombosis in pediatric liver transplantationTransplantation60110912PubMedGoogle Scholar
  13. 13.
    Cronin, D, Alonso, E, Piper, J, Newell, K, Bruce, D, Woodle, E,  et al. 1997Biliary complications in living related donor liver transplantationTranspl Proc2941920CrossRefGoogle Scholar
  14. 14.
    Egawa, H, Uemoto, S, Inomata, Y, Shapiro, A, Asonuma, K, Kiuchi, T,  et al. 1998Biliary complications in pediatric living related liver transplantationSurgery12490110PubMedGoogle Scholar
  15. 15.
    Otte, JB 2004Paediatric liver transplantation — a review based on 20 years of personal experienceTranspl Int1756273PubMedGoogle Scholar
  16. 16.
    Yersig, H, Renz, J, Farmer, D, Hisatake, G, Mc Diamond, S, Busuttil, R 2003One hundred in situ split-liver transplantations: a single center experienceAnn Surg238496505Google Scholar
  17. 17.
    Tanaka, K 2003Progress and future in living donor liver transplantationKeio J Med52739PubMedGoogle Scholar
  18. 18.
    Kawasaki, S, Makuuchi, M, Matsunami, H, Hashikura, Y, Ikegami, T, Nakagawa, Y,  et al. 1998Living related liver transplantation in adultsAnn Surg22726974PubMedCrossRefGoogle Scholar
  19. 19.
    Sugawara, Y, Makuuchi, M 2004Advances in adult living donor liver transplantation; a review based on reports from the Tenth Anniversary of Adult-to-Adult Living Donor Liver Transplantation meeting in TokyoLiver Transpl1071520PubMedCrossRefGoogle Scholar
  20. 20.
    Soejima, Y, Shimada, M, Suehiro, T, Hiroshige, S, Ninomiya, M, Shiotani, S,  et al. 2003Outcome analysis in adult-to-adult living donor liver transplantation using the left lobeLiver Transpl95816PubMedCrossRefGoogle Scholar
  21. 21.
    Hwang, S, Lee, SG, Ha, TY, Ahn, CS, Park, KM, Kim, KH,  et al. 2004Simplified standardized technique for living donor liver transplantation using left liver graft plus caudate lobeLiver Transpl101398405PubMedCrossRefGoogle Scholar
  22. 22.
    Sugawara, Y, Makuuchi, M, Kaneko, J, Kokudo,  2003MELD score for selection of patients to receive a left liver graftTransplantation755734PubMedCrossRefGoogle Scholar
  23. 23.
    Lee, SG, Park, KM, Hwang, S, Lee, YJ, Choi, DN, Kim, KH,  et al. 2001Congestion of right liver graft in living donor transplantationTransplantation718124PubMedCrossRefGoogle Scholar
  24. 24.
    Sugawara, Y, Makuuchi, M 2004Advances in adult living donor liver transplantation: a review based on reports from the 10th anniversary of the adult-to-adult living donor liver transplantation meeting in TokyoLiver Transpl1071520PubMedCrossRefGoogle Scholar
  25. 25.
    Sano, K, Makuuchi, M, Miki, K, Maema, A, Sugawara, Y, Imamura, H,  et al. 2002Evaluation of hepatic venous congestion: proposed indication criteria for hepatic vein reconstructionAnn Surg2362417PubMedCrossRefGoogle Scholar
  26. 26.
    Ghobrial, R, Busuttil, R 2003Future of adult living donor liver transplantationLiver Transpl9S739PubMedCrossRefGoogle Scholar
  27. 27.
    Adam, R, McMaster, P, O'Grady, J, Castaing, D, Klempnauer, J, Jamieson, N,  et al. 2003Evolution of liver transplantation in Europe: report of the European Liver Transplant RegistryLiver Transpl9123143PubMedCrossRefGoogle Scholar
  28. 28.
    Thuluvath, P, Yoo, H 2004Graft and patient survival after adult live donor liver transplantation compared to a matched cohort who received a deceased donor transplantationLiver Transpl1012638PubMedCrossRefGoogle Scholar
  29. 29.
    Humar, A 2003Donor and recipient outcomes after adult living donor liver transplantationLiver Transpl9S424PubMedCrossRefGoogle Scholar
  30. 30.
    Freeman, R 2003The impact of the Model for End-stage Liver Disease on recipient selection for adult living liver donationLiver Transpl9S549PubMedCrossRefGoogle Scholar
  31. 31.
    Marcos, A, Ham, J, Fisher, R, Olzinski, A, Posner, M 2000Single center analysis of the first 40 adult-to-adult living donor liver transplants using the right lobeLiver Transpl6296301PubMedCrossRefGoogle Scholar
  32. 32.
    Lee, SG, Park, KM, Hwang, S, Lee, YJ, Kim, KH, Ahn, CS,  et al. 2002Adult-to-adult living donor liver transplantation at the Asan Medical Center KoreaAsian J Surg2527784PubMedCrossRefGoogle Scholar
  33. 33.
    Bak, T, Wachs, M, Trotter, J, Everson, G, Trovillot, T, Kugelmas, M,  et al. 2001Adult-to-adult living donor liver transplantation using right lobe grafts: results and lessons learned from a single center experienceLiver Transpl76806PubMedCrossRefGoogle Scholar
  34. 34.
    Grewal, H, Thistlethwaite, J, Loss, G, Fisher, J, Cronin, D, Siegel, C,  et al. 1998Complications in 100 living liver donorsAnn Surg2282149PubMedCrossRefGoogle Scholar
  35. 35.
    Fujita, S, Kim, ID, Uryuhara, K, Asonuma, K, Egawa, H, Kiuchi, T,  et al. 2000Hepatic grafts from live donors: donor morbidity for 470 cases of live donationTranspl Int133339PubMedCrossRefGoogle Scholar
  36. 36.
    Renz, J, Roberts, J 2000Long-term complications of living donor liver transplantationLiver Transpl6S736PubMedCrossRefGoogle Scholar
  37. 37.
    Umeshita, K, Fujiwara, K, Kiyosawa, K, Makuuchi, M, Satomi, S, Sugimachi, K,  et al. 2003Operative morbidity of living liver donors in JapanLancet36268790PubMedCrossRefGoogle Scholar
  38. 38.
    CM, Lo 2003Complications and long-term outcome of living liver donors: a survey of 1508 cases in five Asian centersTransplantation75S125Google Scholar
  39. 39.
    Salvalaggio, P, Baker, T, Koffron, A 2004Comparative analysis of live liver donation risk using a comprehensive grading system of severityTransplantation7717657PubMedCrossRefGoogle Scholar
  40. 40.
    Pomfret, E 2003Early and late complications in the right lobe adult living donorLiver Transpl9S459PubMedCrossRefGoogle Scholar
  41. 41.
    Shiffman, M, Brown, R, Olthoff, K, Everson, G, Miller, C, Siegler, M,  et al. 2002Living donor liver transplantation. Summary of a conference at the National Institutes of HealthLiver Transpl817488PubMedCrossRefGoogle Scholar
  42. 42.
    Strong, R 1999Whither living donor liver transplantation (editorial)Liver Transpl Surg55368PubMedCrossRefGoogle Scholar
  43. 43.
    Hayashi, P, Trotter, J 2002Review article: adult-to-adult right hepatic lobe living donor liver transplantationAliment Pharmacol Ther16183341PubMedCrossRefGoogle Scholar
  44. 44.
    Pascher, A, Sauer, I, Walter, M, Lopez-Haeninnen, E, Theruvath, T, Spinelli, A,  et al. 2002Donor evaluation, donor risks, donor outcome and donor quality of life in adult-to-adult living donor liver transplantationLiver Transpl882937PubMedCrossRefGoogle Scholar
  45. 45.
    Brown, R, Russo, M, Lai, M, Shiffman, M, Richardson, M, Everhart, J,  et al. 2003A survey of liver transplantation from living adult donors in the United StatesN Engl J Med34881825PubMedCrossRefGoogle Scholar
  46. 46.
    Simmons, RG, Klein, S, Simmons, RL 1997Living related donors; costs and gainsSimmons, RGKlein, SSimmons, RL eds. Gift of life: the social and psychological impact of organ transplantationWiley and SonsNew York, NY15397Google Scholar
  47. 47.
    Potts, M 2002CorrespondenceJ N Engl Med347616Google Scholar
  48. 48.
    Singer, P, Siegler, M, Whitington, P, Lantos, J, Emond, J, Thistlethwaite, J,  et al. 1989Ethics of liver transplantation with living donorsN Engl J Med3216202PubMedCrossRefGoogle Scholar
  49. 49.
    Shapiro, R, Adams, M 2000Ethical issues surrounding adult-to-adult living donor liver transplantationLiver Transpl6S7780PubMedCrossRefGoogle Scholar
  50. 50.
    Spital, A, Spital, M 1990The ethics of liver transplantation from a living donorN Engl J Med32254950PubMedCrossRefGoogle Scholar
  51. 51.
    Moore, FD 1998Three ethical revolutions: ancient assumptions remodeled under pressure of transplantationTransplant Proc2010617Google Scholar
  52. 52.
    Surman, OS 2002The ethics of partial liver donationN Engl J Med3461038PubMedCrossRefGoogle Scholar
  53. 53.
    Fukunishi, L, Sugawara, Y, Takayama, T, Makuuchi, M, Kawarasaki, H, Surman, OS 2001Psychiatric disorders before and after living-related transplantationPsychosomatics4233743PubMedCrossRefGoogle Scholar
  54. 54.
    Malago, M, Testa, G, Marcos, A, Fung, S, Siegler, M, Cronin, M,  et al. 2001Ethical considerations and rationale of adult-to-adult living donor liver transplantationLiver Transpl79217PubMedCrossRefGoogle Scholar
  55. 55.
    Tanaka, K, Ogura, Y, Kiuchi, T, Inomata, Y, Uemoto, S, Furukawa, H 2004Living donor liver transplantation: Eastern experiencesHPB68894PubMedGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2006

Authors and Affiliations

  • Russell W. Strong
    • 1
  1. 1.University of QueenslandPrincess Alexandra HospitalBrisbaneAustralia

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