Living donor for liver transplantation

Abstract

Since living related liver transplantation was first performed in 1989, more than 150 cases have been performed worldwide, mostly in the United States and Japan. This paper reports the first series of living related liver transplantation in Europe. Twenty living related liver transplantation surgeries were performed over a 13‐mo period, with an overall patient survival of 85%. For patients who underwent elective transplantation (n=13), the survival rate was 100%. Technical complications included one arterial thrombosis necessitating retransplantation and five bile leaks requiring surgical revision. The technical improvements that permit avoidance of these complications are discussed. A detailed description of the living related liver procurement is given. All procurements yielded grafts of excellent quality. No intraoperative complications occurred, and no reoperations were necessary. No heterologous blood transfusion was needed. In two patients, incisional hernias developed after wound infection. Living related liver transplantation does not absolve the transplant community of efforts to promote cadaveric organ procurement. Nevertheless, living related liver transplantation does have the advantage of a readily available graft of excellent quality, permitting transplantation with optimal timing under elective conditions. Several centers are now preparing living related segmental liver transplants, following the model of our protocol, for three reasons: (a) to obtain superior results compared with cadaveric liver transplantation; (b) to overcome cadaveric organ shortage and further reduce pretransplantation mortality and (c) to provide viable organs in countries where cadaveric organ procurement is not established. When performed by a team experienced in pediatric liver transplantation and in adult liver resection, living related liver transplantation is an excellent modality for the treatment of end‐stage liver disease in children. (Hepatology 1994;20:49S‐55S.)

Living-donor liver transplantation in adults: single-center experience

“…In general, perioperative mortality and long-term results after LDLT are comparable to results after cadaver liver transplantation. Even better results for patient and graft survival after LDLT are reached by single groups with a larger experience [13,14]. Especially in tumor patients, liver transplants show the best results with regard to the patient's disease-free survival and the possibility for a cure [15,16] when the patient is in a low-grade state of disease.…”

Alternativen zur Spenderorgantransplantation bei Patienten mit hepatischen Erkrankungen

“…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.…”

Living-donor liver transplantation in children

“…At the University of Hamburg, the first European program of LRLT [14] was developed with nearly 100 cases to date. Until now, more than 1000 LRLTs have been performed worldwide.…”

“…The number and ratio of excluded potential donors varies in a significant way between the different institutions. Initially, only 11 of 43 candidates from our institution were declined because of medical or psychological findings [14]. Emond et al [18] evaluated 134 potential donors and excluded 62 (46%): 16 (12%) because of ABO blood group incompatibility, 27 (20%) because of medical findings and 19 (14%) because of social reasons.…”