Adult living donor liver transplantation: living donation of the right liver lobe

Mittler, Jens; Pascher, Andreas; Jonas, Sven; Pratschke, Johann; Neumann, Ulf; Langrehr, Jan M.; Neuhaus, P.

doi:10.1007/s00423-007-0187-0

Cited by 7 publications

(7 citation statements)

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“…The cholangiogram allows the precise characterization of the anatomy of the biliary tree and determination of the transection plane in the hilar plate. 47 Ramacciato et al 48 stressed that when isolating the hilar structures, the surgeon should isolate the right or left hepatic duct and transect it sharply to leave the peribiliary plexus an intact as possible to preserve the vascularization of the donor biliary system. Minimum dissection of bile duct around the hilum is 35 and Basaran et al 46 Type A 1 : right anterior (RA) hepatic duct (HD) and right posterior (RP) HD combine and form the right hepatic duct (RHD), and this duct combines with left (L) HD in the hepatic hilus.…”

Section: Surgical Considerationsmentioning

confidence: 99%

Biliary complications in living liver donors

Yua

Gotoh

2010

Surg Today

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With the increasing use of living donor liver transplantation (LDLT), the morbidity and mortality of the donors have thus become inevitable problems associated with this procedure. The most common postoperative complications among donors for LDLT involve the biliary tract. The incidence of biliary complications in donors tends to be about 5% based on recent publications. Anatomical variations in the biliary tract, higher predonation alkaline phosphatase levels, and intraoperative blood transfusions are also risk factors for biliary complications in the donors after donation. Donors with biliary complications often show unspecific symptoms and most of the biliary complications can be normally treated by nonsurgical methods. Interventional procedures such as percutaneous placement of a peritoneal drain, percutaneous/endoscopic biliary drainage, and combinations of balloon dilatation and/or stenting are effective in the treatment of bile leakage and biliary stricture. A clear understanding of the biliary anatomy of each donor and refined surgical techniques will help to minimize risk of biliary complications for living liver donors.

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Section: Surgical Considerationsmentioning

confidence: 99%

Biliary complications in living liver donors

Yua

Gotoh

2010

Surg Today

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“…The precise determination of graft and remnant volumes constitutes the most important parameter to prevent postoperative donor and recipient liver failure in adult live donor liver transplantation (ALDLT) [1][2][3] . Middle hepatic vein (MHV)-containing grafts are associated with small remnants whose function may be further impaired by early postoperative venous congestion of their medial sector (segment 4A/ B) [1,4,5] .…”

Section: Introductionmentioning

confidence: 99%

Risk of venous congestion in live donors of extended right liver graft

Radtke¹,

Sgourakis²,

Molmenti³

et al. 2015

WJG

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AIM:To investigate middle hepatic vein (MHV) management in adult living donor liver transplantation and safer remnant volumes (RV). METHODS:There were 59 grafts with and 12 grafts without MHV (including 4 with MHV-5/8 reconstructions). All donors underwent our five-step protocol evaluation containing a preoperative protocol liver biopsy Congestive vs non-congestive RV, remnantvolume-body-weight ratios (RVBWR) and postoperative outcomes were evaluated in 71 right graft living donors. Dominant vs non-dominant MHV anatomy in total liver volume (d-MHV/TLV vs nd-MHV/TLV) was constellated with large/small congestion volumes (CVindex). Small for size (SFS) and non-SFS remnant considerations were based on standard cut-off-RVBWR and RV/TLV. Non-congestive RVBWR was based on non-congestive RV. RESULTS:MHV and non-MHV remnants showed no significant differences in RV, RV/TLV, RVBWR, total bilirubin, or INR. SFS-remnants with RV/TLV < 30% and non-SFS-remnants with RV/TLV ≥ 30% showed Prospective Study Risk of venous congestion in live donors of extended right liver graftArnold Radtke, George Sgourakis, Ernesto P Molmenti, Susanne Beckebaum, Vito R Cicinnati, Hartmut Schmidt,Christoph E Broelsch, Massimo Malagó, Tobias Schroeder Radtke A et al . Liver failure in live donors of right grafts 6009May 21, 2015|Volume 21|Issue 19| WJG|www.wjgnet.com no significant differences either. RV and RVBWR for non-MHV (n = 59) and MHV-containing (n = 12) remnants were 550 ± 95 mL and 0.79 ± 0.1 mL vs 568 ± 97 mL and 0.79 ± 0.13, respectively (P = 0.423 and P = 0.919. Mean left RV/TLV was 35.8% ± 3.9%.Non-MHV (n = 59) and MHV-containing (n = 12) remnants (34.1% ± 3% vs 36% ± 4% respectively, P = 0.148. Eight SFS-remnants with RVBWR < 0.65 had a significantly smaller RV/TLV than 63 non-SFSremnants with RVBWR ≥ 0.65 [SFS: RV/TLV 32.4%(range: 28%-35.7%) vs non-SFS: RV/TLV 36.2% (range: 26.1%-45.5%), P < 0.009. Six SFS-remnants with RV/TLV < 30% had significantly smaller RVBWR than 65 non-SFS-remnants with RV/TLV ≥ 30% (0.65 (range: 0.6-0.7) vs 0.8 (range: 0.6-1.27), P < 0.01. Two (2.8%) donors developed reversible liver failure. RVBWR and RV/TLV were concordant in 25%-33% of SFS and in 92%-94% of non-SFS remnants. MHV management options including complete MHV vs MHV-4A selective retention were necessary in n = 12 vs n = 2 remnants based on particularly risky congestive and non-congestive volume constellations. CONCLUSION:MHV procurement should consider individual remnant congestive-and non-congestive volume components and anatomy characteristics, RVBWR-RV/TLV constellation enables the identification of marginally small remnants.

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“…Worldwide, mortality on transplant waiting lists has been increasing because of persisting donor organ shortage even though the transplant community has adopted various strategies to expand the donor pool, such as accepting extended criteria donors or living donors [11,12]. Therefore, organ donation and transplantation remain dependent on support and a favorable attitude from health care professionals and the general public.…”

Section: Discussionmentioning

confidence: 99%

Medical students’ education on organ donation and its evaluation during six consecutive years: results of a voluntary, anonymous educational intervention study

et al. 2015

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BackgroundOne of the main reasons for organ shortage is insufficient education on organ donation. Knowledgeable medical students could share the information with friends and families resulting in a positive attitude to organ donation of the general public.MethodsDuring six consecutive years (2009 to 2014), we conducted a voluntary, anonymous educational intervention study on organ donation among fourth year medical students in the course of the main surgery lecture at the University of Essen, Germany.ResultsQuestionnaires of 383 students were analyzed. Prior to the specific lecture on organ donation, 64% of the students carried a signed organ donor card with the intention to donate. Further information regarding organ donation was required by 37% of the students. The request for further information was statistically significantly higher among students without a donor card compared to organ donor card carriers (P < 0.0001). After the lecture, the number of students requiring further information decreased statistically significantly to 19% (P < 0.0001).ConclusionsAlready a 45-minute lecture for fourth year medical students significantly decreases their request for further information on organ donation and improves their attitude to organ donation. Continued training on organ donation will help medical students to become disseminators for this important topic in our society.

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Adult living donor liver transplantation: living donation of the right liver lobe

Abstract: Given the ongoing shortage of donor organs, adult LDLT has become a routine treatment option for patients waiting for liver transplantation. The associated inevitable risk for the healthy donor, however, remains ethically controversial.

Cited by 7 publications

References 41 publications

Biliary complications in living liver donors

Biliary complications in living liver donors

Risk of venous congestion in live donors of extended right liver graft

Medical students’ education on organ donation and its evaluation during six consecutive years: results of a voluntary, anonymous educational intervention study

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