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Article: Adult-to-adult live-donor liver transplantation: The current status

TitleAdult-to-adult live-donor liver transplantation: The current status
Authors
Issue Date2006
PublisherSpringer Japan. The Journal's web site is located at http://link.springer.de/link/service/journals/00534/index.htm
Citation
Journal Of Hepato-Biliary-Pancreatic Surgery, 2006, v. 13 n. 2, p. 110-116 How to Cite?
AbstractAdult-to-adult live-donor liver transplantation (ALDLT) has emerged successfully to partially relieve the refractory shortage of deceased donor grafts caused by the increasing demands of patients with endstage liver diseases. Following the first successful live-donor liver transplantation (LDLT) for a child with biliary atresia in 1989, further extension of the technique, using left-lobe liver grafts for LDLT for large adolescents and adults, has resulted in satisfactory graft and patient survival outcomes. However, small-for-size syndrome may occur in some patients with large body size, and in those with acute-on-chronic liver failure or severe portal hypertension. To overcome the problem of graft-to-body-size mismatch, ALDLT, using a right-lobe liver graft was developed. Although routine inclusion of the middle hepatic vein (MHV) in the right-lobe liver graft is still controversial, the importance of providing good venous drainage for the right anterior sector to ensure better early graft function has gained wide recognition. Preservation of the MHV in the donor is intuitively considered important in reducing the donor risk. However, there are scarce data supporting the contention that postoperative complication is related to the absence of the MHV in the left-liver remnant. Duct-to-duct biliary reconstruction has potential advantages over hepaticojejunostomy, and has become the preferred technique in ALDLT. However, biliary complications, especially biliary strictures on long-term follow-up, occur in about 30% of the recipients. The potential beneficial effect of internal or external biliary drainage in reducing the biliary complication rate after duct-to-duct biliary reconstruction in ALDLT also remains controversial. Dual-liver grafts and right-posterior sector grafts have been used in ALDLT, and are reported to result in satisfactory survival outcomes at selected transplant centers. There is no strong evidence supporting the postulate that patients with hepatitis C infection have an inferior survival outcome after ALDLT when compared with recipients of a deceased-donor liver transplant. ALDLT has contributed to satisfactory survival outcomes in patients with hepatocellular carcinoma (HCC). It allows early surgery for the patients and eliminates the uncertainty of prolonged waiting for a deceased-donor liver graft, and the risks of dropout related to disease progression. The exact selection criteria of patients with HCC for ALDLT have yet to be defined. © Springer-Verlag Tokyo 2006.
Persistent Identifierhttp://hdl.handle.net/10722/172907
ISSN
2009 Impact Factor: 1.601
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLiu, CLen_US
dc.contributor.authorFan, STen_US
dc.date.accessioned2012-10-30T06:25:44Z-
dc.date.available2012-10-30T06:25:44Z-
dc.date.issued2006en_US
dc.identifier.citationJournal Of Hepato-Biliary-Pancreatic Surgery, 2006, v. 13 n. 2, p. 110-116en_US
dc.identifier.issn0944-1166en_US
dc.identifier.urihttp://hdl.handle.net/10722/172907-
dc.description.abstractAdult-to-adult live-donor liver transplantation (ALDLT) has emerged successfully to partially relieve the refractory shortage of deceased donor grafts caused by the increasing demands of patients with endstage liver diseases. Following the first successful live-donor liver transplantation (LDLT) for a child with biliary atresia in 1989, further extension of the technique, using left-lobe liver grafts for LDLT for large adolescents and adults, has resulted in satisfactory graft and patient survival outcomes. However, small-for-size syndrome may occur in some patients with large body size, and in those with acute-on-chronic liver failure or severe portal hypertension. To overcome the problem of graft-to-body-size mismatch, ALDLT, using a right-lobe liver graft was developed. Although routine inclusion of the middle hepatic vein (MHV) in the right-lobe liver graft is still controversial, the importance of providing good venous drainage for the right anterior sector to ensure better early graft function has gained wide recognition. Preservation of the MHV in the donor is intuitively considered important in reducing the donor risk. However, there are scarce data supporting the contention that postoperative complication is related to the absence of the MHV in the left-liver remnant. Duct-to-duct biliary reconstruction has potential advantages over hepaticojejunostomy, and has become the preferred technique in ALDLT. However, biliary complications, especially biliary strictures on long-term follow-up, occur in about 30% of the recipients. The potential beneficial effect of internal or external biliary drainage in reducing the biliary complication rate after duct-to-duct biliary reconstruction in ALDLT also remains controversial. Dual-liver grafts and right-posterior sector grafts have been used in ALDLT, and are reported to result in satisfactory survival outcomes at selected transplant centers. There is no strong evidence supporting the postulate that patients with hepatitis C infection have an inferior survival outcome after ALDLT when compared with recipients of a deceased-donor liver transplant. ALDLT has contributed to satisfactory survival outcomes in patients with hepatocellular carcinoma (HCC). It allows early surgery for the patients and eliminates the uncertainty of prolonged waiting for a deceased-donor liver graft, and the risks of dropout related to disease progression. The exact selection criteria of patients with HCC for ALDLT have yet to be defined. © Springer-Verlag Tokyo 2006.en_US
dc.languageengen_US
dc.publisherSpringer Japan. The Journal's web site is located at http://link.springer.de/link/service/journals/00534/index.htmen_US
dc.relation.ispartofJournal of Hepato-Biliary-Pancreatic Surgeryen_US
dc.subject.meshAdulten_US
dc.subject.meshHumansen_US
dc.subject.meshLiver Diseases - Surgeryen_US
dc.subject.meshLiver Transplantation - Methodsen_US
dc.subject.meshLiving Donorsen_US
dc.subject.meshPatient Selectionen_US
dc.titleAdult-to-adult live-donor liver transplantation: The current statusen_US
dc.typeArticleen_US
dc.identifier.emailFan, ST: stfan@hku.hken_US
dc.identifier.authorityFan, ST=rp00355en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1007/s00534-005-1016-xen_US
dc.identifier.pmid16547671-
dc.identifier.scopuseid_2-s2.0-33645059940en_US
dc.identifier.hkuros116879-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-33645059940&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume13en_US
dc.identifier.issue2en_US
dc.identifier.spage110en_US
dc.identifier.epage116en_US
dc.identifier.isiWOS:000236988300008-
dc.publisher.placeJapanen_US
dc.identifier.scopusauthoridLiu, CL=7409789712en_US
dc.identifier.scopusauthoridFan, ST=7402678224en_US

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