Heidelberg's first experiences in establishing a living-donation liver transplantation programme

Abstract

Background. Since indications for liver transplantation (LTx) have increased and the shortage of brain dead transplant organs continues, an increase in deaths related to extended waiting periods can be documented. Living-related LTx (LRLTx) is a good alternative that can help compensate the shortness of organs for transplantation and can reduce waiting periods and deaths related to a long waiting list. We started a LRLTx programme at the transplantation centre, Department of Surgery at the University of Heidelberg to increase our transplantation activities. In this article we present our primary experiences and protocol. Methods. From September 2002 to June 2003, three LRLTx were performed. Indications in recipients were hepatocellular carcinoma in two cases and liver cirrhoses due to hepatitis B in one patient. Two patients received the right liver (segments V-VIII) of their donors. One patient received the complete liver collected as a Domino LTx. All liver transplants were performed without the use of a venous bypass. Results. The peri-and post-operative courses of our donors were without complications, except for an infected intraabdominal bilioma, which was drained interventionally. The donors were fully able to work after the operation. The coordinative and logistical work should not be underestimated. Conclusions. This therapy should only be offered and performed in centres with excellent expert knowledge in liver and transplantation surgery.

Treatment of Hepatocellular Carcinoma: A Systematic Review

“…LDLT is now performed worldwide and has become an alternative to deceased donor liver transplantation (DDLT) [71]. The surgical protocols and evaluation criteria for donors as well as recipients are now well established [72,73]. Recent reports suggest that outcomes for LDLT are similar to those for DDLT in terms of overall survival and recurrence rates, but the waiting time is lower with LDLT than with DDLT [74].…”

LabMELD‐based organ allocation increases total costs of liver transplantation: a single‐center experience

“…Perioperative management and infrastructure as well as surgical technique have improved and are standardized on a high level (16). Since then, operative volume for this procedure has continuously expanded.…”

Living Related Liver Transplantation: The Ultimate Technique to Expand the Donor Pool?

“…We started LDLT at the Department of Surgery, Ruprecht-Karls-University Heidelberg in September 2002 (6,48). Potential candidates for LT according to Eurotransplant criteria were informed on all potential advantages and risks associated with LDLT, laying emphasis on the present risks of morbidity and mortality to the live donors.…”

“…Further, the complex background as to why someone accepts to undergo major abdominal surgery for adult-to-adult LDLT was elucidated carefully. Our institutional evaluation algorithm has been published recently (48). After an evaluation of 100 candidates for LDLT according to our guidelines only 20 eligible candidates were identified for further assessment / check up for LDLT (48).…”

“…Our institutional evaluation algorithm has been published recently (48). After an evaluation of 100 candidates for LDLT according to our guidelines only 20 eligible candidates were identified for further assessment / check up for LDLT (48). As a consequence, in our unit less than 2% (3/ 184) of all LTs (domino transplantations excluded) performed in our unit from September 2003 to January 2005 have been living related while in Germany about 11% of all LTs are living related (47).…”