Adult-to-adult living-donor liver transplantation: The experience of the Université catholique de Louvain

Hepatocellular cancer selection systems and liver transplantation: from the tower of babel to an ideal comprehensive score

“…The role of LDLT in treating HCC patients will become increasingly important, because dropout risk is virtually eliminated [ 74 ]. Important in this (ethical) context is also the fact that recent technical developments have turned LDLT from a “high risk, high return” into a “low risk, high return” procedure [ 75 ]. These considerations imply that LDLT represents a fertile soil to explore further the role of transplantation in the cure of HCC patients.…”

Two‐Stage Recipient Hepatectomy and Left Liver Transplantation to Minimize Risks in Adult‐to‐Adult Living Donor Liver Transplantation: New Concepts

“…Conversely, a minimized immu nosuppression with tacrolimus monotherapy (trough levels, 4-6 ng/mL) and without induction is key for oncological LT recipients. (1) Third, partial LT is reportedly performed with left lateral sectors (segments 2-3) from deceased or living donors. (2,3) However, the preservation of a vascular pedicle that can be anastomosed requires the division of segment 4 vessels so that segment 4 is completely devascularized and bound to atrophy.…”

“…Our experience and standardized surgical technique in adult-to-pediatric LDLT emphasizes that a left donor hepatectomy is a highly reliable procedure (Table 1). (4) The key of adult-to-pediatric LDLT is risk minimization for the donors and recipients because a left hepatectomy (LH) is traditionally associated with fewer and less severe postoperative complications (1,5) and because small patients are well-suited to small grafts. Comparably, adult recipients with no portal hypertension may settle for tiny left liver grafts.…”

“…We have already reported our experience with standard total hepatectomy and LDLT (64 patients), and we showed that 1 in 4 recipients experienced small-for-size syndrome, 1 in 6 had arterial complications, and 1 in 7 resulted in postoperative death. (1) In contrast, a 2-stage approach appears to be a true game changer for the technical hurdles of LDLT. (2,3) On the basis of these assumptions, we recently performed our first case of a 2-stage total hepatectomy coupled with a left liver LDLT, the details of which are extensively reported in Tables 1-3 and the Supporting Materials. With this communication, we report our technical strategy and give a general insight into this topic.…”

Liver transplantation for unresectable hepatic metastases from colorectal cancer: literature review

“…Recently, a study conducted in Louvain, Belgium, demonstrated the feasibility of living related to liver transplant in patients with colorectal cancer and liver metastases; in the present study, the authors included 64 cases submitted to living related transplant between 1998 and 2016, two of them being submitted to liver transplantation for unresectable colorectal liver metastases. One case received a right hemi liver graft, while the second one received a left graft; the authors reported that the main complications encountered in the recipients were the biliary and vascular ones, while three patients developed a small for size syndrome; however, the morbidity was not correlated to the indication for liver transplantation 21 .…”