Live donor liver transplantation: Current status

Abstract

The inequality between supply of grafts and demand for transplants has forced the transplant community to devise ways to increase the number of available livers for transplant (ie, through use of extended criteria donor grafts and living donation). Since 2002, the number of live donor liver transplantations (LDLT) performed has declined due to concerns of donor safety and lack of clear outcome data establishing success equivalent to that of deceased donor liver transplantation (DDLT). Recent data suggest that LDLT outcomes are comparable with those of DDLT, provided a center has performed more than 20 procedures, both in patients with and without hepatitis C. Further studies are needed to define the optimal donor and the ideal recipient for LDLT. Results from a National Institutes of Health-funded consortium of nine transplant centers are highly anticipated. These data are expected to underscore the viability of LDLT as a life-saving therapy for certain patients with end-stage liver disease.

Kidney Function: Glomerular Filtration Rate Measurement with MR Renography in Patients with Cirrhosis

“…This Health Insurance Portability and Accountability Act-compliant study was approved by our institutional review board, and written informed consent was obtained from all patients. The severity of liver disease was assessed by using Child-Pugh class ( 15 ) and model for end-stage liver disease scores ( 16,17 ). All patients underwent an MR examination that included MR renography and liver MR imaging, as well as a radionuclide clearance study on the same day to determine reference GFRs.…”

Ambivalence in living liver donors

“…Living donor adult liver transplantation is now an accepted treatment modality for end‐stage liver disease and leads to patient and graft survival rates equivalent to those seen with deceased donor liver transplantation 1‐4. In areas with long waiting times for deceased donor organs, living donor adult liver transplantation may be one of the only realistic opportunities for avoiding disease progression beyond parameters acceptable for deceased donor liver transplantation.…”

Living Donor Liver Transplantation for Hepatocellular Carcinoma: Defining Criteria to Extend Indications

“…United Network for Organ Sharing has incorporated the Milan criteria in a modified staging system for HCC that is used to allocate organs. Patients with HCC receive 22 points, along with upgrades every 3 months [4].…”

“…The risk for donors is not negligible, with mortality rates between 0.2% and 0.4% reported at the international level for all indications of living donor liver transplantation, and should be taken into consideration [4]. In patients with a high MELD (Model for End-Stage Liver Disease) score, the medical expenses can be intolerably high [9].…”