Live donor liver transplantation

Abstract

With ever-increasing demand for liver replacement, supply of organs is the limiting factor and a significant number of patients die while waiting. Live donor liver transplantation has emerged as an important option for many patients, particularly small pediatric patients and those adults that are disadvantaged by the current deceased donor allocation system. Ideally there would be no need to subject perfectly healthy people in the prime of their lives to a potentially life-threatening operation to procure transplantable organs. Donor safety is imperative and cannot be compromised regardless of the implication for the intended recipient. The evolution of split liver transplantation is the basis upon which live donor transplantation has become possible. The live donor procedures are considerably more complex than whole organ decreased donor transplantation and there are unique considerations involved in the assessment of any specific recipient and donor. Donor selection and evaluation have become highly specialized. The critical issue of size matching is determined by both the actual size of the donor graft and the recipient as well as the degree of recipient portal hypertension. The outcomes after live donor liver transplantation have been at least comparable to those of deceased donor transplantation. Nevertheless, all efforts should be made to improve deceased donor donation so as to minimize the need for live donors. Transplant physicians, particularly surgeons, must take responsibility for regulating and overseeing these procedures.

Liver Remnant Regeneration in Donors After Living Donor Liver Transplantation: Long-Term Follow-Up Using CT and MR Imaging

“…Nevertheless, several donors showed remnant volumes of > 100 % of the preoperative liver volumes during follow-up. While tissue regeneration begins immediately at a cellular level, the process of remodeling has been assumed to continue for longer time periods [28]. Fluid collections, interpreted as bilioma, were postoperatively detected in 4 donors (8.5 %) adjacent to the resection margin.…”

Revisiting the Safety of Living Liver Donors by Reassessing 441 Donor Hepatectomies: Is a Larger Hepatectomy Complication-Prone?

“…Since the initial cases of living donor liver transplantation (LDLT) were performed (1,2), more than 20 years have already passed and LDLT has become one of the standard therapeutic modalities for patients with end stage liver disease (3)(4)(5)(6) as well as hepatocellular carcinoma (7)(8)(9). The safety of living liver donors is of paramount importance and this issue has been aggressively discussed so far (10)(11)(12)(13)(14)(15)(16).…”

Extent of liver resection modulates the activation of transcription factors and the production of cytokines involved in liver regeneration

“…Tissue damage due to the surgical process further decreases the amount of healthy remnant liver tissue leading to an additional reduction in functional liver capacity in the postoperative period [4,5] . This situation can lead to liver insufficiency and, ultimately, to liver failure and death [6][7][8] . Therefore, patients have to fulfil certain criteria, such as the absence of end-stage liver disease, in order to be eligible for extended hepatectomy [1] .…”

“…For the donor, fast liver regeneration is imperative to reduce the probability of liver insufficiency [12,13] . Thus, an improvement in regenerative capacity would enhance donor safety and increase the possibility of including individuals who are not eligible for donation due to insufficient liver size [8,14] .…”