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Overview

Over the past decade, the gap between the number of adult patients in need of liver transplantation and the number of organs donated has increased greatly. This discrepancy has increased both the mean waiting time to undergo transplant and mortality from complications of end-stage cirrhosis for patients on the waiting list. Over the past several years, attempts to address the inadequate supply of organs for transplant have included the use of marginal donors (age, hemodynamics, viral infection). More recently, living donors have been used to address this need.

The concept of using a living donor developed in pediatric transplantation more than a decade ago26, waiting list mortality declined, and the procedure was shown to have excellent recipient results and low risk for morbidity and mortality in the donor. This concept was extended to adult live-donor liver transplant (LDLT). The LDLT procedure involves transplantation of the right hepatic lobe from one adult donor to another, with the first series in the United States presented in 1998.27

Live-Donor Liver Transplant Recipient

LDLT is considered for those patients likely to experience mortality while awaiting a cadaveric organ donor. Table 9.26 outlines those patients who are candidates for LDLT.

Table 9.26. LDLT candidate recipients

A. Pre-MELD

Hepatocellular carcinoma (T4 and T2) Fulminant hepatic failure

Patients not likely to receive cadaveric organ with life expectancy less than 6 months

B. Post-MELD

Hepatocellular carcinoma (exceeding T2 criteria) Complications of cirrhosis, low MELD score GI bleeding

Hepatic encephalopathy Intractable pruritus Recurrent cholangitis Fulminant hepatic failure

Donor Candidacy and Evaluation

Potential donors are evaluated by a donor advocate team, must be complete healthy, and have hepatic size and anatomy compatible with right lobe transplantation (Table 9.27).

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