Partial liver transplantation-living donor liver transplantation and split liver transplantation

Abstract

In the last two decades, liver transplantation (LTx) has become the treatment of choice for several liver diseases including hepatocellular carcinoma in selected cases. Improvements in surgical and anesthesiological procedures have increased patient survival after LTx, resulting in excellent 1-year survival rates. The ratelimiting factor to further increase the number of LTx is the extreme shortage of suitable organs with the consequence that pediatric and adult patients are dying on the waiting list. At present, mortality reported for pediatric and adult patients on the waiting list is 10 to 20%. Living-donor liver transplantation and split liver transplantation are measurements to reduce the severe lack of cadaveric grafts by expanding the donor pool. Major centers around the world now routinely perform partial LTx in infants and adults with survival success equivalent to that after full-size liver transplantation.

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“…However, the number of patients dying on the waiting list increased 40% during the same time in Turkey, similar to our center (20%) and around the world. 5,6 The number of LDLTs increased, while the number of DDLTs did not change in Turkey during the same time as in our center (Figure 1). The number of brain death declarations increased to 1700 in year 2013, but only 379 brain deaths (22%) were approved for deceased donation according to the TODBS database.…”

“…4 In the past 30 years, the number of LTs performed has increased annually, but due to increasing numbers of patients requiring LT and a shortage of deceased donors, a significant number of patients die on waiting lists worldwide. 5,6 Living-donor liver transplant (LDLT) is a safe procedure and the only alternative to deceased-donor liver transplant (DDLT) in regions that do not have enough deceased donors to meet the needs of their waiting lists.…”

Exact CT-Based Liver Volume Calculation Including Nonmetabolic Liver Tissue in Three-Dimensional Liver Reconstruction

“…Other methods for volume estimation have used body weight, body surface, or landmark based algorithms [37]. With regards to liver transplantation, namely LDLT, the minimal graft weight for successful liver transplantation is discussed controversially but is considered to be 1% or more of the recipient's body weight [7,[38][39][40]. However, successful results have even been reported with grafts having a GRWR less than 0.7% [9,41].…”

Mesenchymal Stem Cells Overexpressing C-X-C Chemokine Receptor Type 4 Improve Early Liver Regeneration of Small-for-Size Liver Grafts

“…Liver transplantation (LT) is the only effective therapy for patients with end‐stage liver disease; however, the shortage of donor organs limits its widespread application. Reduced size liver transplantation (RSLT), including living donor LT and split LT, has in part alleviated this problem . However, the ischemia/reperfusion injury associated with RSLT is unavoidable and serious, and it impairs remnant liver regeneration .…”