Advertisement

Liver Transplantation

  • Mark L. SturdevantEmail author
  • Christopher B. Hughes
  • William D. Payne
  • Chris E. Freise
  • Abhinav Humar
Chapter

Abstract

The field of liver transplantation has undergone remarkable advances in the past two decades. An essentially experimental procedure in the early 1980s, a liver transplant is now the treatment of choice for patients with acute and chronic liver failure. Patient survival at 1 year posttransplant has increased from 30 % in the early 1980s to more than 85 % at present. The major reasons for this dramatic increase include refined surgical and preservation techniques, better immunosuppressive protocols, more effective treatment of infections, and improved care during the critical perioperative period. Yet a liver transplant remains a major undertaking, with the potential for complications affecting every major organ system.

Keywords

Liver transplant LTx Surgical technique Operative technique Split liver transplant Living donor liver transplant Donor evaluation Complications 

Supplementary material

Video 7.1

Benching the liver from a deceased donor (Humar) (WMV 63301 kb)

Video 7.2

Deceased donor liver transplant: adult recipient (Humar) (WMV 171609 kb)

Video 7.3

In-situ split of the deceased donor liver for adult/pediatric recipients (John Renz, Hasan Yersiz, Ronald Busutill) (MPG 421110 kb)

Video 7.4

In-situ split of the deceased donor liver for two adult recipients (Humar) (WMV 142803 kb)

Video 7.5

Adult to adult living donor liver transplant using the right lobe: donor procedure (Humar/Sturdevant) (WMV 181647 kb)

Video 7.6

Adult to adult living donor liver transplant using the right lobe: recipient procedure (Humar) (WMV 258336 kb)

Video 7.7

Adult to adult living donor liver transplant using the left lobe: recipient procedure (Chris Friese) (WMV 446707 kb)

Video 7.8

Pediatric liver transplant using a left lateral segment graft (George Mazariegos, Kyle Soltys) (WMV 113787 kb)

Video 7.9

(WMV 113787 kb)

Video 7.10

(MOV 85983 kb)

Suggested Reading

  1. Abecassis MM, Fisher RA, Olthoff KM, Freise CE, Rodrigo DR, Samstein B, et al. Complications of living donor hepatic lobectomy–a comprehensive report. Am J Transplant. 2012;12:1208–17.CrossRefPubMedCentralPubMedGoogle Scholar
  2. Bismuth H. Surgical anatomy and anatomical surgery of the liver. World J Surg. 1982;6:3–9.CrossRefPubMedGoogle Scholar
  3. Botha JF, Langnas AN, Campos BD, Grant WJ, Freise CE, Ascher NL, et al. Left lobe adult-to-adult living donor liver transplantation: small grafts and hemiportocaval shunts in the prevention of small-for-size syndrome. Liver Transpl. 2010;16:649–57.CrossRefPubMedGoogle Scholar
  4. Brown A, Williams R. Long-term postoperative care. In: Maddrey WC, Schiff ER, Sorrell MF, editors. Transplantation of the liver. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001.Google Scholar
  5. Brown Jr R, Russo M, Lai M, Shiffman M, Richardson M, Everhart J, Hoofnagle J. A survey of liver transplantation from living adult donors in the United States. N Engl J Med. 2003;348:818–25.CrossRefPubMedGoogle Scholar
  6. Campos BD, Botha JF. Strategies to optimize donor safety with smaller grafts for adult-to-adult living donor liver transplantation. Curr Opin Organ Transplant. 2012;17:230–4.PubMedGoogle Scholar
  7. Couinaud C. Le foie: etudes anatomiques et chirurgicales. Paris: Masson; 1957.Google Scholar
  8. Everson GT, Kam I. Immediate postoperative care. In: Maddrey WC, Schiff ER, Sorrell MF, editors. Transplantation of the liver. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001.Google Scholar
  9. Fan ST, Lo CM, Liu CL. Technical refinement in adult-to-adult living donor liver transplantation using right lobe graft. Ann Surg. 2000;231:126–31.CrossRefPubMedCentralPubMedGoogle Scholar
  10. Gupta S, Castel H, Rao RV, Picard M, Lilly L, Faughnan ME, et al. Improved survival after liver transplantation in patients with hepatopulmonary syndrome. Am J Transplant. 2010;10:354–63.CrossRefPubMedGoogle Scholar
  11. Humar A, Gruessner R. Critical care of the liver transplant recipient. In: Rippe JM, Irwin RS, Fink MP, Cerra FB, editors. Intensive care medicine. 4th ed. Philadelphia: Lippincott-Raven; 1998.Google Scholar
  12. Icoz G, Kilic M, Zeytunlu M, Celebi A, Ersoz G, Killi R, et al. Biliary reconstructions and complications encountered in 50 consecutive right-lobe living donor liver transplantations. Liver Transpl. 2003;9:575–80.CrossRefPubMedGoogle Scholar
  13. Kim-Schluger L, Florman S, Schiano T, O’Rourke M, Gagliardi R, Drooker M, et al. Quality of life after lobectomy for adult liver transplantation. Transplantation. 2002;73:1593–7.CrossRefPubMedGoogle Scholar
  14. Kiuchi T, Inomata Y, Uemoto S, Asonuma K, Egawa H, Hayashi M, et al. Living-donor liver transplantation in Kyoto, 1997. Clin Transpl. 1997:191–8.Google Scholar
  15. Lee TC, Barshes NR, Washburn WK, Halff GA, Carter BA, Karpen SJ, et al. Split-liver transplantation using the left lateral segment: a collaborative sharing experience between two distant centers. Am J Transplant. 2005;5:1646–51.CrossRefPubMedGoogle Scholar
  16. Marcos A, Fisher RA, Ham JM, Shiffman ML, Sanyal AJ, Luketic VA, et al. Right lobe living donor liver transplantation. Transplantation. 1999;68:798–803.CrossRefPubMedGoogle Scholar
  17. Nashan B, Lueck R, Becker T, Schlitt MH, Grannas G, Klempnauer J. Outcome of split liver transplantation using ex-situ or in-situ splits from cadaver donors. Joint Meeting of the International Liver Transplantation Society, European Liver Transplantation Association, and Liver Intensive Care Group of Europe, Berlin, 11–13 July 2001.Google Scholar
  18. Neuhaus P, Blumhardt G, Bechstein WO, Steffen R, Platz KP, Keck H. Technique and results of biliary reconstruction using side-to-side choledococholedochostomy in 300 orthotopic liver transplants. Ann Surg. 1994;219:426–34.CrossRefPubMedCentralPubMedGoogle Scholar
  19. Raut V, Alikhanov R, Belghiti J, Uemoto S. Review of the surgical approach to prevent small-for-size syndrome in recipients after left lobe adult LDLT. Surg Today. 2014;44:1189–96.CrossRefPubMedGoogle Scholar
  20. Renz JF, Busuttil RW. Adult-to-adult living-donor liver transplantation: a critical analysis. Semin Liver Dis. 2000;20:411–24.CrossRefPubMedGoogle Scholar
  21. Reyes J, Gerber D, Mazariegos GV, Casavilla A, Sindhi R, Rueno J, et al. Split-liver transplantation: a comparison of ex vivo and in situ techniques. J Pediatr Surg. 2000;35:283–9; discussion 289–90.CrossRefPubMedGoogle Scholar
  22. Rogiers X, Malago M, Gawad K, Jauch KW, Olausson M, Knoefel WT, et al. In situ splitting of cadaveric livers. The ultimate expansion of a limited donor pool. Ann Surg. 1996;224:331–9; discussion 339–41.CrossRefPubMedCentralPubMedGoogle Scholar
  23. Shah SA, Grant DR, Greig PD, McGilvray ID, Adcock LD, Girgrah N, et al. Analysis and outcomes of right lobe hepatectomy in 101 consecutive living donors. Am J Transplant. 2005;5:2764–9.CrossRefPubMedGoogle Scholar
  24. Starzl TE, Groth CG, Makowka L. Clio chirurgica liver transplantation. Austin: Silvergirl; 1988.Google Scholar
  25. Strong RW, Lynch SV, Ong TN, Matsunami H, Koido Y, Balderson GA. Successful liver transplantation from a living donor to her son. N Engl J Med. 1990;322:1505–7.CrossRefPubMedGoogle Scholar
  26. Sturdevant M, Dunn T, Gruessner R. Perioperative care of the liver recipient. In: Gruessner RWG, Benedetti E, editors. Living donor organ transplantation. New York: McGraw-Hill; 2008. p. 583–8.Google Scholar
  27. Surman OS. The ethics of partial-liver donation. N Engl J Med. 2002;346:1038.CrossRefPubMedGoogle Scholar
  28. Trotter J, Talamantes M, McClure M, Wachs M, Bak T, Trouillot T, et al. Right hepatic lobe donation for living donor liver transplantation: impact on donor quality of life. Liver Transpl. 2001;7:485–93.CrossRefPubMedGoogle Scholar
  29. Trotter JF, Wachs M, Everson GT, Kam I. Adult-to-adult transplantation of the right hepatic lobe from a living donor. N Engl J Med. 2002;346:1074–82.CrossRefPubMedGoogle Scholar
  30. Umeshita K, Fujiwara K, Kiyosawa K, Makuuchi M, Satomi S, Sugimachi K, et al. Operative morbidity of living liver donors in Japan. Lancet. 2003;362:687–90.CrossRefPubMedGoogle Scholar
  31. Wachs ME, Bak TE, Karrer FM, Everson GT, Shrestha R, Trouillot TE, et al. Adult living donor liver transplantation using a right hepatic lobe. Transplantation. 1998;66:1313–6.CrossRefPubMedGoogle Scholar
  32. Washburn K, Halff G, Mieles L, Goldstein R, Goss JA. Split-liver transplantation: results of statewide usage of the right trisegmental graft. Am J Transplant. 2005;5:1652–9.CrossRefPubMedGoogle Scholar
  33. Wiesner RH. Current indications, contraindications, and timing for liver transplantation. In: Busutill RW, Klintmalm GB, editors. Transplantation of the liver. Philadelphia: W.B. Saunders; 1996.Google Scholar
  34. Wray C, Scovotti JC, Tobis J, Niemann CU, Planinsic R, Walia A, et al. Liver transplantation outcome in patients with angiographically proven coronary artery disease: a multi-institutional study. Am J Transplant. 2013;13:184–91.CrossRefPubMedGoogle Scholar
  35. Yersiz H, Renz JF, Farmer DG, Hisatake GM, McDiarmid SV, Busuttil RW. One hundred in situ split-liver transplantations: a single-center experience. Ann Surg. 2003;238:496–505.PubMedCentralPubMedGoogle Scholar
  36. Zimmerman MA, Trotter JF. Living donor liver transplantation in patients with hepatitis C. Liver Transpl. 2003;9:S52–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  • Mark L. Sturdevant
    • 1
    Email author
  • Christopher B. Hughes
    • 1
  • William D. Payne
    • 2
  • Chris E. Freise
    • 3
  • Abhinav Humar
    • 4
  1. 1.Department of Surgery, Thomas E. Starzl Transplantation InstituteUniversity of Pittsburgh Medical Center, MontefiorePittsburghUSA
  2. 2.Division of Vascular Surgery, Department of SurgeryUniversity of Minnesota Medical SchoolMinneapolisUSA
  3. 3.Division of Transplant SurgeryConnie Frank Transplant Center at the University of California, San FranciscoSan FranciscoUSA
  4. 4.Division of Transplantation, Department of Surgery, Thomas E. Starzl Transplantation InstituteUniversity of Pittsburgh Medical Center, MontefiorePittsburghUSA

Personalised recommendations