Successful Living Donor Liver Transplantation Between Septuagenarians

Abstract

We report a case of a 76-year-old female who underwent living donor right hepatectomy for her 75-year-old husband with recurrent hepatocellular carcinoma. With her voluntary decision, full medical and psychiatric assessment was performed. The operative time was 130 min in the donor and 399 min in the recipient. Both the donor and recipient had an uneventful recovery and were discharged on days 7 and 10, respectively with normal liver function. The couple has had no complication so far and is currently doing well in good health 26 months after living donor liver transplantation.

Impact of Intra-Abdominal Adhesion on Living Donor Right Hepatectomy

“…With a great shortage of organ donors resulting in longer waiting times and increased mortality for patients awaiting liver transplantation, many efforts have been made to expand the living donor pools to increase the applicability of living donor liver transplantation (LDLT). Strategies employing ABO incompatible grafts and careful selection of living donors with liver remnants <30% , obese donors , and elderly donors have been proposed specifically for LDLT in patients who have no other choice. Another challenge is living donor candidates with intra‐abdominal adhesion (IAA), which can make donor surgery even more complicated and difficult because of adhesion formation that causes the intestines or other abdominal structures to adhere to the surface of the liver and abdominal wall.…”

Right lobe living donors ages 55 years old and older in liver transplantation

“…The 76-year-old female donated the right lobe of her liver to her 75-year-old husband. (26) The couple made uneventful recoveries and were discharged on POD 7 and 10, respectively. The couple has had no complication so far and is currently in good health with normal liver function 59 months after surgery.…”

“…A total of 42 (7.8%) donors met the criteria with the oldest being 76 years old. The 76‐year‐old female donated the right lobe of her liver to her 75‐year‐old husband . The couple made uneventful recoveries and were discharged on POD 7 and 10, respectively.…”

Specific issues concerning the management of patients on the waiting list and after liver transplantation

“…Whereas the survival benefit of LDLT relative to DDLT at 10 years has been confirmed, the detrimental effect of severe renal dysfunction on mortality after LT will continue to negatively affect survival after DDLT . The future is bright for LDLT recipients: with experience gained worldwide, not only has the related morbidity dropped to below the thresholds for LT established in national studies like the US A2ALL cohort, but underserved recipients who would never be eligible for DDLT have been added to the pool of successful LT recipients . There is now strong evidence, magnified at experienced centres, of LDLT providing a sustained benefit to recipients with low MELD scores (<15), and a lower mortality on the waiting list is only part of the reason .…”

“…128 The future is bright for LDLT recipients: with experience gained worldwide, not only has the related morbidity dropped to below the thresholds for LT established in national studies like the US A2ALL cohort, but underserved recipients who would never be eligible for DDLT have been added to the pool of successful LT recipients. [129][130][131][132][133] There is now strong evidence, magnified at experienced centres, of LDLT providing a sustained benefit to recipients with low MELD scores (<15), and a lower mortality on the waiting list is only part of the reason. 126,134 Candidates who have decompensated cirrhosis but are otherwise transplantable, and those whose low MELD scores underestimate their risk of death, as in patients with hyponatremia, 135,136 refractory ascites, 137 or recurrent variceal bleeding and contraindications to transjugular intrahepatic portosystemic shunt 138 are just a few of the subgroups of recipients benefiting from LDLT.…”