Expanding Living Donor Liver Transplantation

2021 ◽  
pp. 214-240
Author(s):  
Lainie Friedman ◽  
J. Richard Thistlethwaite, Jr
Keyword(s):  
Liver Transplantation ◽  
Young Children ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Ethical Issues ◽  
Deceased Donor ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Split Liver ◽  
Donor Liver Transplant

In the 1980s in the United States (US), young children in liver failure were at proportionately greater risk of dying on the deceased donor liver transplant (DDLT) waitlist than adults because of the lack of appropriately sized grafts. This led to the development of two deceased donor liver techniques—reduced-size (trimming the graft to decrease its size) and split-liver (where one liver could provide grafts to two candidates). These developments decreased but did not eliminate waitlist mortality for young children. Split-liver DDLT paved the way for living donor liver transplantation (LDLT) in children using the lateral segments of the left lobe. Pediatric LDLT began slowly at only a few centers with successful donor and recipient results. Adult-to-adult LDLT expanded quickly despite many US programs having limited experience, low volumes, and significant donor morbidity. The ethical issues raised by the rapid expansion of adult-to-adult LDLT in the US are discussed.

scholarly journals Living-Donor Liver Transplantation and Hepatitis C

HPB Surgery ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-13 ◽  
Author(s):  
Nobuhisa Akamatsu ◽  
Yasuhiko Sugawara
Keyword(s):  
Liver Transplantation ◽  
Hepatitis C ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Antiviral Treatment ◽  
Sustained Viral Response ◽  
Deceased Donor ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Primary Indication

Hepatitis-C-virus- (HCV-) related end-stage cirrhosis is the primary indication for liver transplantation in many countries. Unfortunately, however, HCV is not eliminated by transplantation and graft reinfection is universal, resulting in fibrosis, cirrhosis, and finally graft decompression. In areas with low deceased-donor organ availability like Japan, living-donor liver transplantation (LDLT) is similarly indicated for HCV cirrhosis as deceased-donor liver transplantation (DDLT) in Western countries and accepted as an established treatment for HCV-cirrhosis, and the results are equivalent to those of DDLT. To prevent graft failure due to recurrent hepatitis C, antiviral treatment with pegylated-interferon and ribavirin is currently considered the most promising regimen with a sustained viral response rate of around 30% to 35%, although the survival benefit of this regimen remains to be investigated. In contrast to DDLT, many Japanese LDLT centers have reported modified treatment regimens as best efforts to secure first graft, such as aggressive preemptive antiviral treatment, escalation of dosages, and elongation of treatment duration.

scholarly journals Adult-to-Adult Living Donor Liver Transplantation

2006 ◽  
Vol 20 (5) ◽  
pp. 339-343 ◽  
Author(s):  
Shimul A Shah ◽  
Gary A Levy ◽  
Lesley D Adcock ◽  
Gary Gallagher ◽  
David R Grant
Keyword(s):  
Liver Transplantation ◽  
Multidisciplinary Team ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Deceased Donor ◽  
Present Review ◽  
Living Donation ◽  
Liver Transplants ◽  
Donor Liver ◽  
Donor Liver Transplantation

The present review outlines the principles of living donor liver transplantation, donor workup, procedure and outcomes. Living donation offers a solution to the growing gap between the need for liver transplants and the limited availability of deceased donor organs. With a multidisciplinary team focused on donor safety and experienced surgeons capable of performing complex resection/reconstruction procedures, donor morbidity is low and recipient outcomes are comparable with results of deceased donor transplantation.

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