Evolving Surgical Approaches in Liver Transplantation

Abstract

The growing discrepancy between the need and the availability of donor livers has resulted in evolving surgical approaches in liver transplantation during the last two decades to expand the donor pool. One approach is to transplant partial grafts, obtained either from a living donor or splitting a cadaveric donor liver. For both surgical methods, it is important to obtain a minimal viable graft volume to prevent small-for-size syndrome and graft failure. This minimal volume, expressed as graft-to-whole body ratio, must be between 0.8 and 1%. Living donor liver transplantation (LDLT) became the primary transplant option in many Asian countries and is increasingly performed as an adjunct transplant option in countries with low donation rates. Split liver transplantation (SLT) is a surgical method that creates two allografts from one deceased donor. The most widely used splitting technique is the division of the liver into a left lateral sectoral graft (segments 2 and 3) for a pediatric patient and a right trisegmental graft (segments 1 and 4 to 8) for an adult patient. Both LDLT and SLT are also important and established methods for the treatment of pediatric patients. Another evolving surgical approach is auxiliary liver transplantation, which describes the transplanting a whole or partial graft with preservation of the partial native liver. This bridging technique is applied in patients with fulminate liver failure and should allow the regeneration of the injured liver with the potential to discontinue immunosuppression. Other methods such as xenotransplantation, as well as hepatocyte and stem cell transplantation, are promising approaches that are still in experimental phases.

Ultrasonography, laboratory, and cholangiography correlation of biliary complications in pediatric liver transplantation

“…For this purpose, in pediatric LT, three surgical procedures have been described, such as hepatic reduction, hepatic bipartition approach (Split), and living related donor. Hepatic reduction is, in general, the most common technique in pediatrics, when the left lateral segments are used (II‐III) . These techniques have permitted an increase in the pool of available organs; however, an increase of vascular and biliary complications have been reported, leading some to consider these biliary complications as the “Achilles' heel” of the pediatric LT .…”

“…Biliary complications rates of about 27–30% have been reported in patients with Split liver grafts . Biliary complications include strictures and biliary leaks among the most frequent.…”

Revisiting the Safety of Living Liver Donors by Reassessing 441 Donor Hepatectomies: Is a Larger Hepatectomy Complication-Prone?

“…Since the initial cases of living donor liver transplantation (LDLT) were performed (1,2), more than 20 years have already passed and LDLT has become one of the standard therapeutic modalities for patients with end stage liver disease (3)(4)(5)(6) as well as hepatocellular carcinoma (7)(8)(9). The safety of living liver donors is of paramount importance and this issue has been aggressively discussed so far (10)(11)(12)(13)(14)(15)(16).…”

Recurrence of non-viral liver disease after orthotopic liver transplantation

“…Post-transplant patient survival is dependent on a number of operative and non-operative factors, but in particular, indication for transplantation (3). Patient survival has increased over the past decade as a result of advances in surgical techniques and immunosuppression (1,4).…”