Anatomical limits in living donor liver transplantation

Abstract

We review the anatomical limits of living donor liver transplantation. Graft size is the fundamental challenge in partial liver transplantation. Insufficient graft size leads to small-for-size syndrome, graft failure, and graft loss. However, smaller grafts can be used safely with surgical techniques to optimize outflow and modulate inflow, thereby minimizing portal hyperperfusion. Meanwhile, anatomical variations are common in the vascular and biliary systems. These variants pose additional challenges for vascular and biliary reconstruction. Recognition and appropriate management of these variants ensure donor safety and reduce recipient morbidity. The ultimate principle of partial liver transplantation is to ensure a sufficient graft volume with unimpeded outflow and reconstructable vascular and biliary systems. On this basis, the anatomical limits of living donor liver transplantation can be safely expanded.

Outcomes of living donor liver transplantation using graft with multiple hepatic arteries on the graft: Propensity score-matched analysis

“…Living donor liver transplantation (LDLT) has emerged as a crucial solution to the organ shortage crisis, offering a lifeline to patients with end-stage liver disease [1]. The use of liver grafts from living donors, despite their potential to expand the donor pool, introduces complexities due to anatomical variations [2]. These variations necessitate refined surgical techniques to ensure the successful viability of the graft and the patient's outcome [3].…”