Liver transplantation from living donors

Rogiers, Xavier; Burdelski, M.; Broelsch, Christoph E.

doi:10.1002/bjs.1800810903

Cited by 24 publications

(9 citation statements)

References 9 publications

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“…Advantages with living donors include the ability to expand the donor pool and the potential to perform transplantation before recipients become critically ill from the underlying disease. 11 The obvious disadvantage is the risk, both short-and long-term, to the donor. 12 SLTs can complement living donor transplants and increase the donor pool.…”

Section: Discussionmentioning

confidence: 99%

Outcome of other organs recovered during in situ split-liver procurements

Thiagarajan

Glessing

Lake

et al. 2001

Liver Transplantation

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Split-liver transplantation is becoming a useful technique to expand the donor pool. Whether the split should be performed in situ or ex situ is not clear. One potential disadvantage of in situ splits is that prolonged surgical time and increased blood loss may negatively affect the function of other solid organs (kidneys, pancreas, and heart) procured from the same donor. Therefore, we studied the function of other organs posttransplantation. Between September 1, 1999, and March 31, 2000, we performed six in situ splits at the University of Minnesota (Minneapolis, MN). These six splits yielded six right-lobe liver grafts and six left-lobe liver grafts, which were transplanted into 12 adult-size recipients. Other grafts obtained from these six donors were as follows: kidney (n ‫؍‬ 11), heart (n ‫؍‬ 4), lungs (n ‫؍‬ 1), pancreas (n ‫؍‬ 2), and kidney-pancreas (n ‫؍‬ 1). We then analyzed posttransplantation function of these grafts and the postoperative course of transplant recipients. All six donors were hemodynamically stable at the time of procurement. Mean donor age was 19.7 years. Mean surgical time for the procurement was 7.4 hours, with an average blood loss of 490 mL during in situ splitting of the liver. The 12 liver grafts showed good initial function with no primary nonfunction. The other organs also showed good function. Of 11 kidney recipients, only 1 patient developed delayed graft function, which resolved within 4 days. In addition, 1 kidney was lost early because of severe acute rejection. For the 10 recipients with functioning kidneys, mean creatinine level at hospital discharge was 2.0 mg/dL, and mean creatinine level after an average 9-month follow-up was 1.3 mg/dL. Of the 4 heart transplant recipients, 3 patients had good graft function immediately posttransplantation, with an ejection fraction greater than 60%, minimal inotropic requirements, and no surgical complications. The fourth heart transplant recipient, a critically ill status 1 patient, had poor initial function and a prolonged intensive care unit stay. At hospital discharge, pancreas and pancreas-kidney transplant recipients were all insulin free, with good urine amylase levels, no surgical or infectious complications, and no evidence of significant pancreatitis posttransplantation. The kidney of the pancreas-kidney transplant recipient functioned immediately; creatinine level after 7 months of follow-up was 1.2 mg/dL. Despite increased surgical time and blood loss, in situ splitting of liver grafts can be accomplished in stable donors without significant negative effects on other organs. (Liver Transpl 2001;7:853-857.) S everal approaches currently are used to help alleviate the shortage of donor livers, including the use of living donors, splitting of cadaver livers, and use of cadaver donors considered marginal in quality. 1 Living donor liver transplantation has gained popularity in the last decade; however, significant concern persists regarding short-and long-term complications for the donor. 2 Split-liver transplants (SLTs), f...

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Section: Discussionmentioning

confidence: 99%

Outcome of other organs recovered during in situ split-liver procurements

Thiagarajan

Glessing

Lake

et al. 2001

Liver Transplantation

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“…Vier Jahre später wurde dann die erste erfolgreiche Split-Lebertransplantation, d. h. die Transplantation von einer Spenderleber auf zwei Empfänger durchgeführt [13]. Unsere Klinik hat auf den Gebieten der Leberlebendspende und der Split-Lebertransplantation die Entwicklung entscheidend mitgeprägt [14,15,16,17]. So wurde hier das erste europäische Programm für Leberlebendspende aufgebaut.…”

Section: Alternative Lebertransplantationsmethodenunclassified

Alternativen zur Spenderorgantransplantation bei Patienten mit hepatischen Erkrankungen

Pollok

Rogiers

2002

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschu

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“…The surgical details of both techniques have been explained elsewhere [28,[31][32][33]. Performing the donor hepatectomy laparoscopically reduces post-operative morbidity and shortens recovery time for the donor [34].…”

Section: Split Liver Transplantationmentioning

confidence: 99%

Pediatric Liver Transplantation: A Surgical Perspective and New Concepts

et al. 2014

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The first successful liver transplantation was carried out in 1967, and the recipient was a pediatric patient. Since then, many challenges have been overcome and, nowadays, 1-year patient survival after liver transplantation is about 90 % in pediatric patient populations. Standardization of surgical technique, development of better immunosuppressive medications, improved understanding of caring for patients with end-stage liver disease, and improvements in anesthesia and intensive care have had a tremendous impact on graft and patient survival. Despite all improvements, challenging issues in pediatric liver transplantation remain. In this article, we address some of these problems. and living donor liver transplantation (LDLT); improvement of intensive care treatment; development of new immunosuppressive medications; improved understanding of the balance between immunosuppression and opportunistic infection; and the adoption of a multidisciplinary team approach to patient care, which includes collaboration between transplant surgery, pediatric hepatology, pediatric intensive care, nephrology, pulmonary, cardiology, infectious disease, psychiatry, social work, pharmacy, and nutrition.Despite these good outcomes, many challenges remain in pediatric LT. Appropriate patient selection, organ shortage and the organ allocation algorithm, time of transplantation, technical problems, and opportunistic infections are some of the problems faced by transplant programs on a daily basis. This chapter addresses some of these issues.

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Liver transplantation from living donors

Cited by 24 publications

References 9 publications

Outcome of other organs recovered during in situ split-liver procurements

Outcome of other organs recovered during in situ split-liver procurements

Alternativen zur Spenderorgantransplantation bei Patienten mit hepatischen Erkrankungen

Pediatric Liver Transplantation: A Surgical Perspective and New Concepts

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