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Semin Liver Dis 2000; 20(4): 411-424
DOI: 10.1055/s-2000-13153
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Adult-to-Adult Living-Donor Liver Transplantation: A Critical Analysis

John F. Renz1,2 , Ronald W. Busuttil2
  • 1Department of Surgery, University of California San Francisco, California
  • 2The Dumont-UCLA Liver Transplantation Center, University of California, Los Angeles, Los Angeles, California
Further Information

Publication History

Publication Date:
31 December 2000 (online)

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ABSTRACT

Adult-to-adult living-donor liver transplantation is the most recent achievement in the evolution of strategies to increase donor organ supply. Justification of the procedure has evolved from increased organ-waiting times, wait-list morbidity and mortality of adult transplant candidates. Successful application of adult-to-adult living-donor liver transplantation mandates unique surgical, medical, and donor considerations as these procedures predispose to unique complications resulting from anatomic variations, technical considerations, and the transplantation of ``partial'' grafts. Additionally, because the magnitude of the donor operation is greater and potentially fraught with serious short and long term morbidity and possibly mortality, the utilization of living-donors for adult liver transplantation raises bio-ethical concerns heretofore not encountered. This review explores the current state of adult-to-adult living-donor liver transplantation.

KEYWORD

adult living-donor liver transplantation - organ donation - liver - liver transplant surgery

REFERENCES

  • 1 Smith B. Segmental liver transplantation from a living donor.  J Pediatr Surg . 1969;  4 126-132
    CrossrefPubMedGoogle Scholar
  • 2 Raia S, Nery J R, Mies S. Liver transplantation from live donors.  Lancet . 1989;  2 497
    PubMedGoogle Scholar
  • 3 Broelsch C E, Emond J C, Thistlethwaite R. Liver transplantation with reduced-size donor organs.  Transplantation . 1988;  45 519-523
    PubMedGoogle Scholar
  • 4 Zitelli B J, Malatack J J, Gartner J C. Evaluation of the pediatric patient for liver transplantation.  Pediatrics . 1987;  78 559-565
    PubMedGoogle Scholar
  • 5 Strong R W, Lynch S V, Ong T N. Successful liver transplantation from a living donor to her son.  N Engl J Med . 1990;  322 1505-1507
    PubMedGoogle Scholar
  • 6 Broelsch C E, Whitington P F, Emond J C. Liver transplantation in children from living related donors.  Ann Surg . 1991;  214 428-439
    CrossrefPubMedGoogle Scholar
  • 7 Tanaka K, Uemoto S, Tokunaga Y. Surgical techniques and innovations in living related liver transplantation.  Annals of Surgery . 1993;  217 82-91
    CrossrefPubMedGoogle Scholar
  • 8 Ozaki C F, Katz S M, Monsour H P, Wood R P. Vascular reconstruction in living-related liver transplantation.  Transplantation Proceedings . 1994;  30 167-169
    PubMedGoogle Scholar
  • 9 Kuang A A, Rosenthal P, Roberts J P. Decreased mortality from technical failures improves results in pediatric liver transplantation.  Archives of Surgery . 1996;  131 887-893
    PubMedGoogle Scholar
  • 10 Broelsch C E. Personal communication. March 2000
    Google Scholar
  • 11 Emond J C, Heffron T G, Kortz E O. Improved results of living related liver transplantation with routine application in a pediatric program.  Transplantation . 1993;  55 885-840
    PubMedGoogle Scholar
  • 12 Ryckman F C, Flake A W, Fisher R A. Segmental orthotopic hepatic transplantation as a means to improve patient survival and diminish waiting-list mortality.  J Pediatr Surg . 1991;  26 422-428
    CrossrefPubMedGoogle Scholar
  • 13 Otte J B, Goyet J V, Reding R. Living related donor liver transplantation in children:the Brussels experience.  Transplantation Proceedings . 1996;  28 2378-2379
    PubMedGoogle Scholar
  • 14 Sindhi R, Rosendale J, Mundy D. Impact of segmental grafts on pediatric liver transplantation-A review of the United Network for Organ Sharing Scientific Registry data (1990-1996).  J Pediatr Surg . 1999;  34 107-110
    CrossrefPubMedGoogle Scholar
  • 15 Renz J F, de Roos M, Rosenthal P. Early Transplantation Optimizes Growth Restoration in Children with Extra-Hepatic Biliary Atresia. American Association for the Study of Liver Diseases, November 1996, Chicago, IL
    Google Scholar
  • 16 McDiarmid S V, Gornbein J A, DeSilva P J. Factors affecting growth after pediatric liver transplantation.  Transplantation . 1999;  67 404-411
    PubMedGoogle Scholar
  • 17 Bartosh S M, Thomas S E, Sutton M M. Linear growth after pediatric liver transplantation.  J Pediatr . 1999;  135 624-631
    PubMedGoogle Scholar
  • 18 Heffron T G. Living related liver transplantation.  Semin Liver Dis . 1995;  15 165-172
    PubMedGoogle Scholar
  • 19 Harihara Y, Makuuchi M, Kawarasaki H. Initial experience with living-related liver transplantation at the University of Tokyo.  Trans Proc . 1998;  30 129-131
    PubMedGoogle Scholar
  • 20 Emond J C, Renz J F. Surgical anatomy of the liver and its application to hepatobiliary surgery and transplantation.  Semin Liver Dis . 1994;  14 158-168
    PubMedGoogle Scholar
  • 21 Emond J C, Renz J F, Ferrell L D. Functional analysis of grafts from living donors: implications for the treatment of older recipients.  Annals of Surgery . 1996;  224 544-549
    CrossrefPubMedGoogle Scholar
  • 22 Kiuchi T, Kasahara M, Uryuhara K. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors.  Transplantation . 1999;  67 321-327
    PubMedGoogle Scholar
  • 23 Heffron T G, Emond J C, Whitington P F. Biliary complications in pediatric liver transplantation.  Transplantation . 1992;  53 391-395
    Google Scholar
  • 24 Matsukawa H, Egawa H, Inomata Y. Biliary complication sin living related liver transplantation. Abstracts from the Fourth Congress International Liver Transplantation Society, October 1997
    Google Scholar
  • 25 Reichert P R, Renz J F, Bacchetti P. Biliary Complications of reduced-organ liver transplantation, liver transplantation and surgery.  . 1998;  4 343-349
    PubMedGoogle Scholar
  • 26 Kawasaki S, Makuuchi M, Ishizone S. Liver regeneration in recipients and donors after transplantation.  Lancet . 1992;  339 580-581
    CrossrefPubMedGoogle Scholar
  • 27 Nakagami M, Morimoto T, Itoh K. Patterns of restoration of remnant liver volume after graft harvesting in donors for living related liver transplantation.  Transplant Proc . 1998;  30 195-199
    CrossrefPubMedGoogle Scholar
  • 28 Renz J F, Mudge C L, Heyman M B. Donor selection limits use of living related liver transplantation.  Hepatology . 1995;  22 1122-1126
    CrossrefPubMedGoogle Scholar
  • 29 Sterneck M, Nischwitz U, Fischer L. Evaluation and morbidity of the living liver donor in pediatric liver transplantation.  Transplant Proc . 1995;  27 1164-1165
    PubMedGoogle Scholar
  • 30 Morimoto T, Tananka A, Ikai I. Donor safety in living related liver transplantation.  Transplant Proc . 1995;  27 1166-1169
    PubMedGoogle Scholar
  • 31 Ohkohchi N, Katoh H, Orii T. Complications and treatments of donors and recipients in living-related liver transplantation.  Transplant Proc . 1998;  30 3218-3220
    CrossrefPubMedGoogle Scholar
  • 32 Tojimbara T, Fuchinoue S, Nakajima I. Analysis of postoperative liver function of donors in living-related liver transplantation: comparison of the type of donor hepatectomy.  Transplantation . 1998;  66 1035-1039
    PubMedGoogle Scholar
  • 33 Grewal H, Thistlewaite J, Loss G. Complications in 100 living liver donors.  Ann Surg . 1998;  228 214-219
    CrossrefPubMedGoogle Scholar
  • 34 Rogiers X, Malago M, Habib N. In situ splitting of the liver in the heart-beating cadaveric organ donor for transplantation in two recipients.  Transplantation . 1995;  59 108-1085
    PubMedGoogle Scholar
  • 35 Azoulay D, Astarcioglu I, Bismuth H. Split-liver transplantation. The Paul Brousse policy.  Ann Surg . 1996;  224 737-746
    CrossrefPubMedGoogle Scholar
  • 36 Rogiers X, Malago M, Gawad K. In situ splitting of cadaveric livers: the ultimate expansion of the donor pool.  Annals of Surgery . 1996;  224 331-336
    CrossrefPubMedGoogle Scholar
  • 37 Goss J A, Yersiz H, Shackleton C R. In situ splitting of the cadaveric liver for transplantation.  Transplantation . 1997;  64 871-877
    CrossrefPubMedGoogle Scholar
  • 38 Broelsch C E, Emond J C, Whitington P F. Application of reduced-size liver transplants as split grafts, auxiliary orthotopic grafts, and living related segmental transplants.  Annals of Surgery . 1990;  212 368-377
    PubMedGoogle Scholar
  • 39 Pichlmayr R, Ringe B, Gubernatis G. Transplantation einer spenderleber auf Zwis Empfanger Eine neue methode in der weitzentwicklung der lebesegment transplantation.  Langenbecks Archiv Chir . 1989;  373 127-130
    PubMedGoogle Scholar
  • 40 Emond J C, Whitington P F, Thistlethwaite J R. Transplantation of two patients with one liver.  Ann Surg . 1990;  212 14-22
    CrossrefPubMedGoogle Scholar
  • 41 Emond J C, Heffron T G, Thistlethwaite Jr R J. Innovative approaches to donor scarcity: a critical comparison between split liver and living related liver transplantation.  Hepatology . 1991;  14 92A
    PubMedGoogle Scholar
  • 42 Mirza D F, Achilleos O, Pirenne J. Encouraging results of split-liver transplantation.  Brit J Surg . 1998;  85 494-497
    CrossrefPubMedGoogle Scholar
  • 43 Rela M, Heaton N D. Split-liver transplantation.  Brit J Surg . 1998;  85 881-883
    CrossrefPubMedGoogle Scholar
  • 44 Reyes J, Gerber D, Mazariegos G ZV. Split-liver transplantation: a comparison of ex vivo and in situ techniques.  J Ped Surg . 2000;  35 283-289
    CrossrefPubMedGoogle Scholar
  • 45 Hertl M, Malago M, Rogiers X. Surgical approaches for expanded organ usage in liver transplantation.  Trans Proc . 1997;  29 3683-3686
    PubMedGoogle Scholar
  • 46 Malago M, Rogiers X, Hertl M. Optimization of the use of the cadaveric liver.  Trans Proc . 1998;  30 3902-3903
    PubMedGoogle Scholar
  • 47 Urata K, Kawasaki S, Matsunami H. Calculation of child and adult standard liver volume for liver transplantation.  Hepatology . 1995;  21 1317-1321
    CrossrefPubMedGoogle Scholar
  • 48 Kawasaki S, Makuuchi M, Ishizone S. Liver regeneration in recipients and donors after transplantation.  Lancet . 1992;  339 580-581
    CrossrefPubMedGoogle Scholar
  • 49 Couinaud C. Le Foie, Etudes Anatomiques et Chirurgicales.  Paris: Masson; 1957
    Google Scholar
  • 50 Bismuth H. Surgical anatomy and anatomical surgery of the liver.  World J Surg . 1982;  6 3-9
    CrossrefPubMedGoogle Scholar
  • 51 Habib N, Tanaka K. Living-related liver transplantation in adult recipients: a hypothesis.  Clinical Transplantation . 1995;  9 31-34
    PubMedGoogle Scholar
  • 52 Wachs M E, Bak T E, Karrer F M. Adult living donor liver transplantation using a right hepatic lobe.  Transplantation . 1998;  66 1313-1316
    PubMedGoogle Scholar
  • 53 Marcos A, Ham J M, Fisher R A. Single center analysis of the first forty adult to adult living donor liver transplants using the right lobe.  Liver Transplantation (in press). 2000; 
    PubMedGoogle Scholar
  • 54 Emond J C, Heffron T G, Whitington P F, Broelsch C E. Reconstruction of the hepatic vein in reduced size hepatic transplantation.  Surgery, Gynecology and Obstetrics . 1993;  176 11-15
    PubMedGoogle Scholar
  • 55 Marcos A, Fisher R A, Ham J M. Right lobe living donor liver transplantation.  Transplantation . 1999;  6 798-803
    PubMedGoogle Scholar
  • 56 Makuuchi M, Kawasaki S, Noguchi T. Donor hepatectomy for living related partial liver transplantation.  Surgery . 1993;  113 395-402
    PubMedGoogle Scholar
  • 57 Miller C M, Emre S, Ben-Haim M. Liver Transplantation Using Left Lobe Grafts From Adult Donors in Adult Recipients: Preliminary Experience. American Society of Transplant Surgeons 1999
    Google Scholar
  • 58 Schwartz, M. ``U.S. experience with living donor liver transplantation: the Mt. Sinai experience,''. Controversies in Transplantation. The University of Colorado, March 18, 2000
    Google Scholar
  • 59 Lo C M, Fan S T, Liu C L. Extending the limit on the size of adult recipient in living donor liver transplantation using extended right lobe graft.  Transplantation . 1997;  63 1524-1529
    CrossrefPubMedGoogle Scholar
  • 60 Lo C M, Fan S T, Chan J. Adult-to-adult living donor liver transplantation using extended right lobe grafts.  Ann Surg . 1997;  226 261-270
    CrossrefPubMedGoogle Scholar
  • 61 Fan S T, Lo C M, Liu C L. Technical refinement in adult-to-adult living donor liver transplantation.  Ann Surg . 2000;  23 126-131
    PubMedGoogle Scholar
  • 62 Kato T, Nery J R, Morcos J J. Successful living related liver transplantation in an adult with fulminant hepatic failure.  Transplantation . 1997;  64 415-417
    PubMedGoogle Scholar
  • 63 Uemoto S, Inomata Y, Tanaka K. Living Donor Liver Transplantation for Fulminant Hepatic Failures. American Society of Transplant Surgeons 1999
    Google Scholar
  • 64 Bak T, Everson G, Wachs M E. Living-donor liver transplantation for adults with fulminant hepatic failure: an underutilized resource?.  Liver Trans Surg . 1999;  5 C45(abstr)
    PubMedGoogle Scholar
  • 65 Busuttil R W. The Potential Role of Adult-to-Adult Living Donor Liver Transplantation. Controversies in Transplantation, The University of Colorado, March 18, 2000
    Google Scholar
  • 66 Monsour Jr P H, Wood R P, Opsaki C. Utility of preoperative biopsy in live-related donor patients for liver transplantation.  Trans Proc . 1994;  30 138-140
    PubMedGoogle Scholar
  • 67 Fishbein T, Fiel M, Emre S. Use of livers with microvesicular fat safely expands the donor pool.  Transplantation . 1997;  64 248-251
    PubMedGoogle Scholar
  • 68 Markin R, Wisecarver J, Radio S. Frozen section evaluation of donor livers before transplantation.  Transplantation . 1993;  56 1403-1409
    PubMedGoogle Scholar
  • 69 Urena M, Moreno Gonzalez E, Romero C. An approach to the rational use of steatotic donor livers in liver transplantation.  Hepatogastroenterology . 1999;  46 1164-1173
    PubMedGoogle Scholar
  • 70 Renz J F, Reichert P R, D'Albuquerque L AC. Anatomic variatons encountered in adult living-donor and split-liver transplantation.  Ann Surg (submitted).
    PubMedGoogle Scholar
  • 71 Reichert P R, Renz J F, D'Albuquerque, et al. Surgical anatomy of the left lateral segment as applied to living-donor and split-liver transplantation: a clinico-pathologic study.  Ann Surg (in press). 2000; 
    PubMedGoogle Scholar
  • 72 Marcos A. Right lobe living donor liver transplantation: a review.  Liver Transplantation . 2000;  6 3-20
    PubMedGoogle Scholar
  • 73 Cheng Y, Chen C, Huang T. Magnetic resonance imaging of the hepatic veins with angular reconstruction: application in living related liver transplantation.  Transplantation . 1999;  68 267-271
    PubMedGoogle Scholar
  • 74 Fulcher A, Turner M, Capps G. MR cholangiography: technical advances and clinical applications.  Radiographics . 1999;  19 25-41
    PubMedGoogle Scholar
  • 75 Marcos A. U.S. experience with living donor liver transplantation: the Medical College of Virginia experience. Controversies in Transplantation, The University of Colorado, March 18, 2000
    Google Scholar
  • 76 Trotter J F. The selection of donors and recipients for living donor liver transplant. Controversies in Transplantation, The University of Colorado, March 18, 2000
    Google Scholar
  • 77 Todo S. Adult-to-adult living donor liver transplantation: the Japanese experience. Controversies in Transplantation, The University of Colorado, March 18, 2000
    Google Scholar
  • 78 Inomata Y, Uemoto S, Egawa H. Right Lobe Graft in Living Donor Liver Transplantation, American Society of Transplant Surgeons, 1999 . 
    Google Scholar
  • 79 Testa G, Malago M, Broelsch C E. Adult-to-adult living donor liver transplantation: the European experience. Controversies in Transplantation, The University of Colorado, March 18, 2000
    Google Scholar
  • 80 Renz J F, Busuttil R W. Adult-to-adult living donor liver transplantation: a survey of North American transplant centers.  N Engl J Med (submitted). 2000; 
    PubMedGoogle Scholar
  • 81 Strong R W. Whither living donor liver transplantation?.  Liver Transplantation and Surgery . 1999;  5 536-538
    PubMedGoogle Scholar
  • 82 Malago M, Rogiers X, Burdelski M, Broelsch C. Living related liver transplantation: 36 cases at the University of Hamburg.  Transplant Proc . 1994;  26 3620-3621
    PubMedGoogle Scholar
  • 83 Fair J H. Personal Communication. Controversies in Transplantation, The University of Colorado, March 18, 2000
    Google Scholar
  • 84 Sudan D L, Shaw Jr W B, Fox I J, Langnas A N. Long-term follow-up of auxiliary orthotopic liver transplantation for the treatment of fulminant hepatic failure.  Surgery . 1997;  122 771-777
    CrossrefPubMedGoogle Scholar
  • 85 van Hoek D, de Boer J, Boudjema K. Auxiliary versus orthotopic liver transplantation for acute liver failure. EURALT Study Group.  European Auxiliary Liver Transplant Registry. Hepatology . 1999;  30 699-705
    CrossrefPubMedGoogle Scholar
  • 86 Wachs M. U.S. experience with living donor liver transplantation: the University of Colorado experience. Controversies in Transplantation, The University of Colorado, March 18, 2000
    Google Scholar
  • 87 Singer P A, Siegler M, Whitington P F. Ethics of liver transplantation with living donors.  N Engl J Med . 1989;  321 620-622
    PubMedGoogle Scholar
  • 88 Iwatsuki S, Starzl T E. Personal experience with 411 hepatic resections.  Ann Surg . 1988;  208 421-434
    CrossrefPubMedGoogle Scholar
  • 89 Capussotti L, Polastri R. Operative risks of major hepatic resections.  Hepatogastroenterology . 1998;  45 184-193
    PubMedGoogle Scholar
  • 90 Fan S T, Lo C M, Liu C L. Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths.  Ann Surg . 1999;  229 322-330
    CrossrefPubMedGoogle Scholar
  • 91 Fan S T, Ng I OL, Poon R TP. Hepatectomy for hepatocellular carcinoma. The surgeon's role in long-term survival.  Arch Surg . 1999;  134 1124-1130
    PubMedGoogle Scholar