Living Related Liver Transplantation in Adults

Abstract

ObjectiveTo evaluate the outcome of living related liver transplantation (LRLT) in adult patients and to assess graft size disparity and graft regeneration. Summary Background DataAlthough LRLT has been accepted as an optional life-saving procedure for pediatric patients with end-stage liver disease, the feasibility of LRLT for adult patients has not been reported with reference to a clinical series. MethodsAdult-to-adult LRLT was performed using whole left lobar grafts in 13 patients (5 with primary biliary cirrhosis, 6 with familial amyloid polyneuropathy, 1 with biliary atresia, and 1 with citrullinemia). The 13 donors comprised 5 husbands, 3 sons, 2 sisters, 2 fathers, and 1 mother. The ratio of the graft volume to standard liver volume (GV/SV ratio) was calculated for use as a parameter of graft size disparity. ResultsAlthough the liver graft was markedly small for size (GV/SV ratio 32%-59% at the time of LRLT), none of the 13 patients developed postoperative liver failure. Eleven of the patients are still alive and well with satisfactory graft function 2 to 35 months after LRLT. Graft liver volume increased rapidly after LRLT and approximated the standard liver volume with time. ConclusionsOur LRLT program for adult patients has produced good results. LRLT in adults can be indicated for selected donor-recipient combinations.Since Broelsch et al.' reported the first successful series in Western countries and also in Japan.2-8 The initial of living related liver transplantations (LRLTs), the use series of LRLTs reported by Broelsch et al. was limited of this innovative surgical treatment has steadily increased to infants with a body weight < 15 kg, and only the left lateral segment of the donor liver was used as a graft.

Living-related liver transplantation for patients with fulminant and subfulminant hepatic failure

“…Efforts have been made to use LRLT for critical cases of FHF, 9 and for adult patients in whom small-for-size grafts have been used. 22 In our series of 106 LRLTs, the reasons for transplantation were biliary atresia in 52, FHF or SFHF in 14, primary biliary cirrhosis in 12, familial amyloid polyneuropathy in 11, citrullinemia in 5, Alagille' s syndrome in 4, and others in 8 patients. Thirtyseven LRLTs (35%) were performed on adult patients.…”

Auxiliary liver transplantation: how to improve regeneration of the native liver by surgery

“…In clinical ALT, the graft can be reduced to a right liver (approximately 65 YO of the whole liver volume), a left liver (35 YO) or a left lobe (20%) [2,4,12]. In ALT for FHF, the necessity of quick restoration of liver function and reversal of cerebral oedema argues for the use of the right liver [2,4, 141.…”

Dual liver transplantation

“…At present, there are two standards worldwide: one is ratio of grafts to recipients' weight (GRWR) and the other is ratio of grafts volume to recipients' standard liver volume (GV/SLV). It is generally thought that the former should be more than 0.8% (Fan et al, 2000), and the latter should be more than 40% (Kawasaki et al, 1998). According to the Fan et al (2000) criteria, the volume of remnant liver should exceed 30%, while Lee et al (2001b) believes that the volume of remnant liver should exceed 35% (Kawasaki et al, 1998).…”

“…It is generally thought that the former should be more than 0.8% (Fan et al, 2000), and the latter should be more than 40% (Kawasaki et al, 1998). According to the Fan et al (2000) criteria, the volume of remnant liver should exceed 30%, while Lee et al (2001b) believes that the volume of remnant liver should exceed 35% (Kawasaki et al, 1998). Previous study has shown, in Table 2 in the first seven cases, average GRWR and GV/SLV to be 1.06% and 58.1%, respectively, with good results, but from Cases 8 to 25, GV/SLV ranges from 46.6% to 78.9% with three patients dying (Lee et al, 2001b).…”

“…The potential solutions to this problem are to raise the extent of resection of donor liver by the way of harvesting the right lobe of the liver, which theoretically accounts for 60% to 70% of the total liver mass, or to transplant dual grafts into one recipient. Harvesting the right lobe of the donor is not always safe, depending primarily on the volume of the remaining left lobe (Kawasaki et al, 1998). Even though the recipient may receive an adequate graft volume, the remaining left lobe may be not enough for donor safety.…”