Secondary non-resectable liver tumors: A single-center living-donor and deceased-donor liver transplantation case series

The use of nondirected donor organs in living donor liver transplantation: Perspectives and guidance

“…Although living donor grafts have been used successfully for nontraditional transplant indications such as isolated colorectal cancer metastases, select hilar or intrahepatic cholangiocarcinomas, combined cholangiocarcinoma‐HCCs, and beyond Milan Criteria HCCs, this early adaptation phase of using ND‐LLDs should not include this group, as there is insufficient evidence regarding compromised short and long‐term outcomes of these recipients. [ 64–67 ] The use of living donors for patients with MELD score exceptions should be guided by anticipated access to deceased donor transplantation relative to the recipient’s risk of waitlist dropout. Potential recipients who have approved directed living donors should be considered for ND‐LLD grafts if they are participating in LPE or initiation of a chain where ND‐LLD grafts could increase the donor pool and provide access to a patient without such an option. Assessment of appropriate graft weight to body weight ratio is complex and must include consideration of not only size but other factors such as recipient MELD, donor age, and graft steatosis. Techniques for inflow/outflow modulation have been successfully used in LDLT to expand the lower size acceptance of liver grafts.…”

Two‐Stage Recipient Hepatectomy and Left Liver Transplantation to Minimize Risks in Adult‐to‐Adult Living Donor Liver Transplantation: New Concepts

“…Comparably, adult recipients with no portal hypertension may settle for tiny left liver grafts. (6) Through an upper midline incision, we carried out an open left hepatic resection with the procurement of the middle hepatic vein.…”

Controversy Over Liver Transplantation or Resection for Neuroendocrine Liver Metastasis

“…The rationale behind LT to treat unresectable liver tumors was originally conceived by Starzl in his pioneering studies (34). Despite the technical success, poor oncological outcomes after LT in the 1960-90s faded away the enthusiasm (23,34).…”

“…Careful selection of LT candidates remains critical to justify the use of any graft, including split and living donor grafts. NELM patients usually do not present with portal hypertension and can usually well tolerate small size grafts (34,49,50). These patients, if selected for LT, must benefit from a MELD exception status to secure timely transplantation, and this can probably best be achieved using partial livers such as split and living donor LT. Public discussions must be avoided such as that seen following the transplantation of Apple CEO Steve Jobs (34,51,52).…”