Adult-to-adult living donor liver transplantation: Operative techniques to optimize the recipient's outcome

Abstract

Adult-to-adult living donor liver transplantation (LDLT) is widely accepted today with good outcomes and safety reported worldwide for both donor and recipient. Nonetheless, it remained a highly demanding technical and complex surgery if undertaken. The last two decades have seen an increased in adult-to-adult LDLT following our first report of right lobe LDLT in overcoming graft size limitation in adults. In this article, we discussed the operative techniques and challenges of adult right lobe LDLT incorporating the middle hepatic vein, which is practiced in our center for the recipient operation. The various issues and challenges faced by the transplant surgeon in ensuring good recipient outcome are explored and discussed here as well. Hence, it is important to understand that a successful recipient operation is dependent of multifactorial events starting at the preoperative stage of planning, understanding the intraoperative technical challenges and the physiology of flow modulation that goes hand-in-hand with the operation. Therefore, one needs to arm oneself with all the possible knowledge in overcoming these technical challenges and the ability to be flexible and adaptable during LDLT by tailoring the needs of each patient individually.

Endoscopic therapy for biliary strictures complicating living donor liver transplantation: Factors predicting better outcome

“…Management of biliary strictures with endotherapy, i.e ., ERC with endobiliary stenting, is the treatment of choice especially for patients with AS[ 22 ]. They are notoriously difficult to treat with a recurrence rate between 9%-37%[ 23 ]. However, contrary to this, a report from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study consortium (A2ALL)[ 24 ] suggested a comparable efficacy of endoscopic treatment in anastomotic strictures (in both DDLT as well as LDLT setting) based on which a recommendation to reserve endoscopic therapy as a first line treatment for all patients with anastomotic strictures could be made[ 22 ].…”