Partial Liver Transplantation

Dept. of Surgery, Erasmus University Hospital Rotterdam, The Netherlands.
Scandinavian journal of gastroenterology. Supplement 02/2001; 36(234):98-102. DOI: 10.1080/003655201753265181
Source: PubMed


Since the introduction of the split-liver transplantation procedure 15 years ago a variety of partial liver transplantations have been developed. The earliest form of split-liver transplantation consisted of reduction of a whole liver graft to just the left lateral segment or the left liver lobe, which was then small enough to transplant to a young child. The rest of the liver was discarded. This method partially solved the great need for liver grafts for children but as the remaining part of the liver was discarded the method was in fact detrimental for adults on the waiting list. Further surgical development resulted in splitting of the liver ex vivo into two transplantable partial grafts: the left part to a child and the right lobe to an adult. This procedure was successfully introduced but the complicated logistics resulted in prolonged cold ischemia times for the grafts. In order to keep the cold ischemia time as short as possible, the in situ split-liver technique was developed, in which the liver was split in the post-mortem donor. Refinement of this operation led to results which were superior to those obtained with the ex vivo method; moreover, it opened the door to living-donor liver transplantation. The first successful procedure was performed from a mother to a child, who received the mother's left liver segment. The introduction of this technique resulted over the years in a decrease in the pediatric waiting list to almost zero. As the demand for organs increases every year and the number of donors remains constant in Western countries, the right-lobe living-donor liver transplantation for adults has been introduced. Introduction of all forms of partial liver transplantation has relieved the pressure on waiting lists, especially for children but also for adults. There are, however, serious concerns regarding the high morbidity and mortality rates associated with the living-donor donation procedure.

Download full-text


Available from: Jeroen De Jonge, Dec 10, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Living-related liver transplantation is widely accepted as a treatment for patients with end-stage liver disease, with survival rates of up to 80%. Liver transplant recipients are at risk for the same postoperative complications as any patient undergoing a major intraabdominal operation, in addition to several complications specific to this procedure. Maintenance immunosuppression relies principally on administration of tacrolimus and methylprednisolone. Nevertheless, approximately 36% of liver transplant recipients suffer acute rejection in the early posttransplant period and require bolus steroid therapy as a rescue agent. Vascular complications, including hepatic arterial thrombosis and portal vein thrombosis, are additional major problems. When they occur in the immediate postoperative period, they can produce fulminant hepatic necrosis requiring retransplantation, so intensive anticoagulation therapy is needed as prophylaxis against these vascular complications. If thrombosis of the hepatic artery or portal vein is diagnosed early in the postoperative course, emergency thrombectomy with reanastomosis should be attempted. Outflow obstruction by hepatic vein stenosis sometimes causes liver dysfunction, pleural effusion, and hepatosplenomegaly. Percutaneous transhepatic or transjugular approached hepatic vein dilatation is very useful in case of hepatic vein stenosis. Recipients are generally immunocompromised secondary to immunosuppressive therapy and their poor clinical condition and are at high risk for postoperative infection. Infection is a major cause of morbidity and the most common cause of death in liver transplant recipients. Antibiotic, antifungal, and antiviral agents are used empirically, and serologic examinations and bacterial investigations of blood, sputum, stool, urine, and discharge from drains should be performed as well as antibiotic sensivity tests when necessary. Other complications related to the operation are intraabdominal bleeding, bile leakage, biliary anastomotic stenosis, and intestinal perforation. The postoperative course of liver transplant recipients with these complications depends on making an accurate diagnosis promptly and initiating appropriate management. Postoperative complications of living-related liver transplantation are protean, so it is very important to communicate with professionals in each specialized field to ensure optimal treatment.
    No preview · Article · Jan 2004 · Journal of Nippon Medical School
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hepatic resection with concomitant periods of ischemia and reperfusion (I/R) are required to perform partial liver transplantation procedures such as split liver or living donor transplantation. Although great progress has been made using these types of surgeries, there remains substantial risk to both donors and recipients, with a significant number of patients developing liver injury and failure during the course these operations. Therefore, there is need to investigate the different mechanisms responsible for the tissue injury induced by ischemia and reperfusion of a reduced-size liver (RSL+I/R) with the ultimate objective of developing new therapeutic agents that may limit hepatocellular damage induced during partial liver transplantation. This review summarizes recent studies that have been performed in a mouse model of RSL+I/R. In addition, we present data demonstrating how the pathophysiological mechanisms identified in this model compare to those observed in a rat model of RSL transplantation.
    No preview · Article · Sep 2006 · Pathophysiology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: 1. Hepatic resection with concomitant periods of ischaemia and reperfusion (I/R) is required to perform reduced-size liver (RSL) transplantation procedures, such as living donor or split liver transplantation. Although a great deal of progress has been made using these types of surgical procedures, a significant number of patients develop tissue injury from these procedures, ultimately resulting in graft failure. 2. Because of this, there is a real need to understand the different mechanisms responsible for the tissue injury induced by I/R of RSL transplantation (RSL + I/R), with the ultimate goal to develop new and improved therapeutic agents that may limit the tissue damage incurred during RSL transplantation. 3. The present paper reviews the recent studies that have been performed examining the role of reactive metabolites of oxygen and nitrogen in a mouse model of RSL + I/R. In addition, we present data demonstrating how the pathophysiological mechanisms identified in this model compare with those observed in a model of RSL transplantation in rats.
    Preview · Article · Oct 2007 · Clinical and Experimental Pharmacology and Physiology