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

Abstract

Today, living donor liver transplantation (LDLT) is well established in many centers as a therapeutic method for end-stage liver disease. LDLT is an option for selected cases and is still under development. From the beginning of LDLT until now, many innovations have been presented and as a consequence both the surgical and medical complications in both donors and recipients reduced greatly. As a benefit, this procedure enriches the donor organ pool and reduces the imbalance between the scarcity of organ resource and organ demand; however, LDLT will not solve the problem of organ shortage. Because the modality of LDLT is still associated with morbidity and mortality of the donors, recipient's graft-size match problems and substantial surgical complications, ethical issues of live organ donation must be discussed. Nevertheless, estimates of patient survival and complications in both donors and recipients should incorporate waiting time mortality. With this background, the extended indications for LDLT compared with cadaveric liver transplantation would have to be discussed in many cases. In this brief review, we focus on potential complications for both donors and recipients after adult-to-adult LDLT, discuss ethical problems and controversies with special interest on the perspective and potentials of this surgical method.

Outcomes in hepatitis C virus–infected recipients of living donor vs. deceased donor liver transplantation

“…The reasons for the difference in outcomes of HCV‐infected live donor transplant recipients early in a center's experience vs. later are not completely clear. However, most transplant physicians recognize the unique technical challenges in performing living donor transplants in adults, and several publications attest to the higher rate of graft loss early in the posttransplant period related to vascular problems, biliary complications, and small‐for‐size syndrome 10, 11. These technical issues have great relevance in the first 90 days posttransplantation.…”

Impaired liver regeneration and increased oval cell numbers following T cell–mediated hepatitis

“…1,2 Complicating factors including the activation of the innate immune response are often present in the regenerating organs, although their effects on the overall outcome of tissue regeneration are not well understood. The current series of studies has focused on the effects of T cell-mediated liver injury during the regenerative response.…”

Treatment of Hepatocellular Carcinoma: A Systematic Review

“…In contrast, Saidi et al reported that recipients of leftlobe LDLT had a greater mean duration of stay (24.9 days vs. 18.2 days), higher re-transplantation rates (20.3% vs. 10.9%), lower allograft survival, and inferior survival compared with recipients of DDLT [76]. LDLT should be carefully considered because donor morbidity and mortality still exist, and problems such as matching the graft size with the recipient area and postoperative complications cannot be avoided [77].…”