Live Donor Liver Transplant View Full Text


Ontology type: schema:Chapter     


Chapter Info

DATE

2016-09-23

AUTHORS

Sung-Gyu Lee , Deok-Bog Moon

ABSTRACT

Adult living donor liver transplantation (LDLT) has become a life-saving procedure due to the limited availability of deceased donor organs in many parts of the world. It continues to be a technically challenging procedure and involves inherently complex ethical issues. Donor safety remains the priority; however, a successful recipient outcome after LDLT is also paramount. The safety margin is small for both recipient and donor, each case should be tailored to the patients, and every step of the procedure must be planned and performed meticulously. Over the last two decades, many of the issues related to the technical design of adult LDLT procedures have been solved; there does however remain room for further innovation. A better understanding of the complex surgical anatomy and physiologic differences of adult LDLT helps avoid small-for-size (SFS) graft syndrome, graft congestion from outflow obstruction, and graft hypoperfusion from portal flow steal. Size limitations of partial grafts and donor safety issues can be overcome with dual grafts and modified right lobe (MRL) grafts that preserve the donor’s middle hepatic vein trunk. LDLT is a more complex operation than DDLT, requiring delicate dissection around the hilum as high as possible in order to obtain maximum length of individual structures, allowing for implantation of the smaller-sized living partial liver graft vessels. For technically successful LDLT, the following four conditions should be satisfied: adequate graft volume to avoid small-for-size syndrome, good outflow to avoid congestion, adequate portal inflow to enhance graft regeneration, and secure bile duct anastomosis to avoid biliary leak. However, the risk of surgical complications still remains higher when compared to DDLT. Crucial to maintaining good outcomes following LDLT is a robust multidisciplinary approach with surgical, radiological, and medical teams and a wide range of ancillary services. More... »

PAGES

1-20

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/978-3-319-05543-5_5-2

DOI

http://dx.doi.org/10.1007/978-3-319-05543-5_5-2

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1044111996


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