Right-lobe LDLT is an effective therapeutic option for patients with acute-on-chronic hepatitis B liver failure. It results in satisfactory survival outcomes comparable to those in patients undergoing LDLT for elective conditions.

To achieve a uniformly successful right lobe LDLT, the right lobe graft must contain a patent middle hepatic vein. With a completely patent middle hepatic vein, a graft size of >35% of the estimated standard graft weight may be sufficient for recipient survival. Hypothermia, which predisposes to coagulopathy and is enhanced by the use of venovenous bypass and massive blood, and blood product transfusion must be avoided.

The mortality rate among children with fulminant hepatic failure (FHF) on the waiting list for cadaveric donor liver transplantation (CDLT) is high. Results of emergency CDLT in this situation often are unsatisfactory, and a long-term survival rate less than 30% has been reported. Live donor liver transplantation (LDLT) for FHF in children has been advocated, but is reported rarely. We present our experience with LDLT in children with FHF. Between September 1993 and December 2002, primary LDLT was performed for 26 children; 8 of these children had FHF. Patient demographics, clinical and laboratory data, surgical details, complications, and graft and patient survival are reviewed. Four boys and four girls received left-lateral segment (n ‫؍‬ 7) and full left-lobe (n ‫؍‬ 1) grafts. Mean age was 2.9 ؎ 1.2 years (range, 3 months to 11 years). Causes of FHF were drug induced in 2 patients and idiopathic in 6 patients. One child received a blood group-incompatible graft. Two patients died; 1 patient of cytomegalovirus infection at 8.6 months and 1 patient of recurrent hepatitis of unknown cause at 2.8 months after LDLT. The child who received a mismatched graft had refractory rejection and underwent a second LDLT with a blood group-compatible graft 19 days afterward. He eventually died of lymphoproliferative disease. Another patient developed graft failure related to venous outflow obstruction and survived after retransplantation with a cadaveric graft. With a median follow-up of 13.2 months (range, 2.8 to 60.3 months), actuarial graft and patient survival rates were 50% and 62.5%, respectively. Survival results appear inferior compared with those of 18 children who underwent LDLT for elective conditions during the same study period (graft survival, 89%; P ‫؍‬ .051; patient survival, 89%; P ‫؍‬ .281). Although survival outcomes are inferior to those in elective situations, LDLT is a timely and lifesaving procedure for children with FHF. (Liver Transpl 2003;9:1185-1190.) T he mortality rate of patients with fulminant hepatic failure (FHF) on the waiting list for cadaveric donor liver transplantation (CDLT) can be as high as 90% in Asian countries where cadaveric organ donation is scarce. Even in high-volume western centers, the mortality rate is still approximately 20%. 1 Live donor liver transplantation (LDLT) has been shown to improve the survival outcome of adult patients in highurgency situations for liver transplantation. 2 In children with chronic liver disease, LDLT has proved to be a viable option for obtaining liver grafts in a timely fashion and improving the outcome of liver transplantation. In addition, with the recent advances in splitliver transplantation, including the technique of in situ split, there have been major improvements in postoperative graft function and survival of pediatric recipients. The combination of split-liver transplantation and LDLT has abolished deaths on the waiting list, thus raising the question of whether LDLT is still necessary in elective situations. 3 However, experience wit...