A technique of orthotopic liver transplantation using a segmental graft from living donors was
developed in the dog. Male mongrel dogs weighing 25–30 kg were used as donors and 10–15 kg as
recipients. The donor operation consists of harvesting the left lobe of the liver (left medial and left
lateral segments) with the left branches of the portal vein, hepatic artery and bile duct, and the left
hepatic vein. The grafts are perfused in situ through the left portal branch to prevent warm ischemia.
The recipient operation consists of two phases: 1total hepatectomy with preservation of the inferior
vena cava using total vascular exclusion of the liver and veno-venous bypass, 2implantation of the graft
in the orthotopic position with anastomosis of the left hepatic vein to the inferior vena cava and portal,
arterial and biliary reconstruction. Preliminary experiments consisted of four autologous left lobe
transplants and nine non survival allogenic left lobe transplants. Ten survival experiments were
conducted. There were no intraoperative deaths in the donors and none required transfusions. One
donor died of sepsis, but all the other donor dogs survived without complication. Among the 10 grafts
harvested, one was not used because of insufficient bile duct and artery. Two recipients died
intraoperatively of air embolus and cardiac arrest at the time of reperfusion. Three dogs survived, two
for 24 hours and one for 48 hours. They were awake and alert a few hours after surgery, but eventually
died of pulmonary edema in 2 cases and of an unknown reason in the other. Four dogs died 2–12 hours
postoperatively as a result of hemorrhage for the graft's transected surface. An outflow block after
reperfusion was deemed to be the cause of hemorrhage in these cases. On histologic examination of the
grafts, there were no signs of ischemic necrosis or preservation damage.This study demonstrates the technical feasibility of living hepatic allograft donation. It shows that it is
possible, in the dog, to safely harvest non ischemic segmental grafts with adequate pedicles without
altering the vascularization and the biliary drainage of the remaining liver. We propose that this
technique is applicable to human anatomy.
Segmental Liver Transplantation From Living Donors Report of the Technique and Preliminary Results in Dogs
