Problems in adult living donor liver transplantation using the right hepatic lobe.

Full Abstract

BACKGROUND:
Adult living donor liver transplantation (LDLT) is now widely applied to patients, children or adults, and the graft extends from the left hepatic lobe to the right hepatic lobe. Harvesting the right hepatic lobe would mean putting the donor at high risk. The congestion of a graft may cause small-for-size syndrome. The safety of the donor and its evaluation, which are related to the outcome for the recipient, play an important role in LDLT. How to decrease the congestion of the graft is another challenge to transplant experts.

DATA SOURCES:
A literature search from MEDLINE about adult LDLT in recent years was made to analyze the safety of the living donor and the innovation of surgical techniques for preventing small-for-size syndrome.

RESULTS:
The top priority for adult LDLT is donor safety. Preoperative donor evaluation consists of three stages:
phase 1 for general evaluation, phase 2 for laboratory tests, and phase 3 for radiological evaluation of graft volume and vessel anatomy. The potential pathogenic mechanisms of small-for-size syndrome seem to be related to persistent portal hypertension and portal overperfusion. Improved surgical techniques for decreasing portal hypertension and preventing congestion of a graft may reduce the incidence of small-for-size syndrome. The improved techniques include reconstruction of the tributaries of the middle hepatic vein, end-to-side portocaval shunting, ligation of the splenic artery, dual-graft transplantation, and modified reconstruction of hepatic veins.

CONCLUSION:
With the careful preoperative assessment and the safety of the living donor, as well as improved surgical techniques, adult LDLT using the right lobe is safe.

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Author information

Author/s: Pan, Guang-Dong (GD); Yan, Lu-Nan (LN);

Affiliation: Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, China. pgdhx(-atsign-)126.com

Journal and publication information

Publication Type: Journal Article; Review

Journal: Hepatobiliary & pancreatic diseases international : HBPD INT (Hepatobiliary Pancreat Dis Int), published in China. (Language: eng)

Reference: 2006-Aug; vol 5 (issue 3) : pp 345-9

Dates: Created 2006/08/16; Completed 2006/12/19;

PMID: 16911929, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Humans
Liver - blood supply

Liver - blood supply
Liver Transplantation - methods
Living Donors

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