Selection of donors for living donor liver transplantation in a single center of a developing country: Lessons learned from the first 100 cases

Abstract

The selection of donors for living donor liver transplantation (LDLT) is one of the most important features in this kind of surgery. The aim of this study is to describe our initial experience in the donor evaluation process. From December 2001 to January 2005, 104 donors were evaluated for 70 recipients (65 potential donors were evaluated for 39 adult recipients, and 39 donors for 31 pediatric recipients). Only 30 donors were able to donate: 13 for the adult group, and 17 for the pediatric one. In general, the utilization rate of potential donors was 28.8% (30/104). For the adult patients, 65 potential donors were seen to perform 13 LDLT, which represents a utilization rate of potential donors of 20%. For the pediatric patients, this rate was 43.6%. The exclusion criteria were clinical in 22 cases (21%), anatomical in 13 cases (13%), psychosocial in nine cases (9%), and others in 12 (12%). Death of recipients led to exclusion 18 of donors (17%). Thirty-three percent of adults and 55% of pediatric recipients who had at least one potential donor to start the evaluation process were able to identify a living donor. In conclusion, the first limit for LDLT is the rigorous donor evaluation.

Is there any difference between right hepatectomy and left lateral sectionectomy for living donors? As much you cut, as much you hurt?

“…Details of the pre-operative donor evaluation, as well as surgical technique have been described previously. 8,9 Right and left liver donors were submitted to prior computed tomography (CT) volumetry to assure a remnant liver with, at least, 30% of the total liver volume. Left lateral sector donors did not undergo CT volumetry prior to surgery.…”

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

“…While LDLT is a life saving procedure for the recipient, it is a potentially lethal operation for the donor. Therefore, very stringent criteria have to be fulfilled prior to hepatectomy to ensure donor safety [9][10][11] . For the donor, fast liver regeneration is imperative to reduce the probability of liver insufficiency [12,13] .…”

Hepatic artery reconstruction in pediatric living donor liver transplantation under 10 kg, without microscope use

“…Preoperative angiography was performed in all donors until 2005 and seldom after that time due to angioCT introduction. Our donor evaluation process has been described elsewhere (23). According with our donor evaluation protocol for LDLT, none of the potential donors for pediatric patients were excluded due to anatomical reasons such as arterial diameter or anatomy.…”