Living-donor hepatectomy in right-sided round-ligament liver: importance of mapping the anatomy to the left medial segment

Left-sided gallbladder (LSGB) and right-sided round ligament (RSRL) are very infrequent findings, mostly described in Oriental patients, that have associated anatomical variations. An abnormal portal vein branching, mainly to segment IV, is strongly associated with RSRL. Living-donor liver transplantation requires that both the graft and the remnant liver have adequate vascular supply and volumes. Abnormal vascularization of segment IV then threatens this goal. There have been scarce reports of the feasibility of living-donor hepatectomy under these conditions, all in Oriental populations. We present a case of an Occidental living liver donor with RSRL, and discuss the associated anatomical variations of the portal vascular supply of the liver, with its implications in planning a living-donor hepatectomy.     

Living-donor kidney transplantation

The number of living donations is increasing in Europe and especially in Germany. The reasons seem to be a continuous shortage of cadaveric organs, better results after living related and living unrelated donation, and a high willingness in the population to donate. Various legal prerequisites have to be fulfilled in different countries. In general, careful donor evaluation is necessary to avoid excessive risk in the donor. Nephrectomy for transplantation can be performed via various approaches; microinvasive surgical techniques have been introduced, but are not yet established. Immunosuppression in living related donation is no different from that in cadaveric transplantations. In conclusion, living donation seems to be an adequate alternative to cadaveric donation. Moreover, results are twice as good as cadaveric donation with regard to long-term function. Received: 25 October 1999 Accepted: 27 October 1999     

活体肝移植

将恶性肿瘤或不可逆性肝功能衰竭的良性终末期病肝切除,随即将经手术切取一健康肝脏植入解剖原位,以恢复正常肝功能,抢救生命,是为原位肝移植.     

Living-donor kidney transplantation in children

Living-donor transplantation has several obvious advantages for children: better graft-survival than cadaveric-transplantation, the possibility to be pre-emptive and avoid dialysis and its burden to the child, to be programmed during school holidays. However, its negative aspects must not be ignored. They are mainly psychological and concern the adolescent. The affective burden of both living-donation and transplantation is so strong that a psychological check-up is mandatory for the donor but also for the recipient and even the non-donor parent. In the medical evaluation of the donor, specific explorations, such as the search of a genetic mutation, could be necessary in the case of hereditary renal disease.     

活体肝移植手术之经验

自１９８９年Ｒａｉａ等［１］报告人类首例活体肝移植（ｌｉｖｉｎｇ　ｒｅｌａｔｅｄ　ｌｉｖｅｒ　ｔｒａｎｓｐｌａｎｔａｔｉｏｎ,ＬＲＬＴ）以来,　ＬＲＬＴ因供肝来源广、质量高、排斥轻、预后较好和费用低等优点而备受推崇,成为研究热点之一,其技术也得以迅速发展。至２０００年末,全球完成活体肝移植已近１０００例,其中绝大多数报道集中于日本、北美和欧洲部分国家,平均１年生存率近９０％,２年生存率超过８５％,已被公认为缓解供肝来源匮乏最有效的方法之一。我院活体肝移植始于１９９５年１月,并获得成功［２］;此后…     

Living-donor pancreas and small-bowel transplantation

Background: In contrast to renal and liver transplantation, only a limited number of pancreas and intestinal live-donor transplants have so far been reported. Patients: The vast majority of live segmental pancreas transplants have been performed at the University of Minnesota. From 1979 to 1993, a total of 78 solitary pancreas transplants – 28 after kidney and 49 pancreas transplants alone – were performed and, from 1994 to August 1999, 27 simultaneous pancreas/kidney transplants. For the first intestinal transplant, a segment of ileum from the mother was used in Boston in 1964. In 1970, 170 cm of jejuno-ileum from a human leukocyte antigen (HLA)- identical sister was removed and transplanted in New York. In 1988, an intestinal transplant from a haplotype-identical sister was performed at Kiel University, Germany. In the 1990s, a few more intestinal transplants from live donors were reported to the registry. Results: No death occurred among pancreas or intestinal donors. Altogether, seven pancreas donors required splenectomy and several donors required drainage of abscesses or fluid collections. Three of the 78 pancreas donors and at least two of the 27 pancreas/kidney donors required insulin post-donation. Twenty-seven of the solitary segmental pancreas transplants failed for technical reasons. Graft survival of technically successful pancreas transplants was 68% after 1 year and 38% after 10 years. Patient and renal allograft survival of combined kidney/pancreas transplants after 1 year was 100%, while 1-year pancreas survival was 84%. The first recipient of a live-donor intestinal transplant died only 12 h after surgery. The second case lived for 79 days and was able to eat for 6 weeks. A patient transplanted in 1988 lived for 4 years mainly on oral nutrition. Many of the live-donor intestinal transplants carried out in the 1990s became long-term survivors. Conclusion: Pancreas and small-bowel transplantation using organs from live donors is possible in experienced centers, with no donor mortality and excellent survival rates for recipients and grafts. Since abnormal glucose tolerance post-donation cannot be excluded with certainty and since, for the time being, there is no pancreas or small-bowel shortage in Europe, live donation of these organs should be restricted mainly to highly sensitized patients with a cross-match-negative relative or HLA-identical donor-intestinal recipient combinations. Received: 20 October 1999 Accepted: 27 October 1999     

Living-donor liver transplantation in children

Introduction: Living- related liver transplantation (LRLT) for paediatric recipients was developed 10 years ago to overcome the high mortality on the waiting list. Since then, liver transplantation programs around the world have begun to employ this method with encouraging results. This review describes the actual status of LRLT in children, aspects of donor selection, donor risks, and surgical technique, as well as an update of the results of the leading LRLT programs in the world. The donor operation has matured to the stage of being a standardised, teachable procedure with a low risk of morbidity or mortality. However, there is a percentage of potential donations that have to be declined for medical or socio- psychological reasons. LRLT provides grafts of excellent quality and short cold ischemic times. A major advantage is the fact that the optimal moment for the transplantation procedure can be chosen. Together with split-liver techniques, LRLT has a positive effect on the general situation of the paediatric waiting list for liver transplantation, with a reduction of pre-transplant mortality to nearly 0%. Received: 14 October 1999//Accepted: 20 October 1999     

Living-donor liver transplantation with monosegments

BACKGROUND: Living-donor liver transplantation is now an established technique to treat children with end-stage liver disease. Implantation of left-lateral segment grafts can be a problem in small infants because of a large-for-size graft. We report 10 cases of transplantation using monosegment grafts from living donors. METHOD: Of 506 children transplanted between June 1990 and June 2002, 10 patients (median age 196 days, median weight 5.9 kg) received monosegment living-donor liver transplants. The indication for using this technique was infants with an estimated graft-to-recipient weight ratio of over 4.0%. RESULTS: Graft and patient survival was 80.0%. There were no differences in donor operation time and blood loss between monosegmentectomy and left-lateral segmentectomy (n=281). Monosegmental transplantation had a high incidence of vascular complications (20.0%). CONCLUSION: Monosegmental living- donor liver transplantation is a feasible option with satisfactory graft survival in small babies with liver failure.     

Living-donor liver transplantation in adults

End-stage liver disease is being treated by liver transplantation. Despite legislative and social efforts, the number of cadaveric organs suitable for liver transplantation has not grown to match the increasing demand. The insufficient number of grafts results in high mortality for patients on the waiting list and prolonged waiting times with increasing morbidity. Following the success of living related-donor segmental liver transplantation in children, an amended concept has been applied to the adult patients. The early experience with this technique, the process concerning the selection of the donor for the recipient, the risks of the donor, and the future evolution of living related-donor liver transplantation are the topics of this article. Received: 15 October 1999 Accepted: 20 October 1999     

Living-donor liver transplantation: an overview

It has been 16 years since the first successful living-donor liver transplant was performed from a parent to a child. The overall recipient and graft survival, together with a low morbidity and mortality in donors, have resulted in the widespread acceptance of the procedure by both the transplant community and the public at large. Adult-to-adult living-donor liver transplantation has been evolving over the past decade. Despite living-donor transplant patients being better-risk candidates than those who receive a graft from a deceased donor, and well-established and experienced units achieving satisfactory results, overall recipient and graft survival recorder by registries can only be described as suboptimal. This, combined with the high morbidity and not-insignificant mortality amongst donors makes expansion of adult-to-adult liver transplantation hard to justify on a risk-benefit analysis.     

Living-donor lobar lung transplantation for lymphangioleiomyomatosis

Living-donor lobar lung transplantation seems to be best suited for children and small adults because only two lobes are transplanted. However, the amount of tolerable size discrepancy between donors and recipients is currently unknown. We report two cases of lymphangioleiomyomatosis with hyperinflation successfully treated with living-donor lobar lung transplantation in spite of large size disparity.     

Living-donor liver transplantation for hepatocellular carcinoma

Transplant surgeons have long dreamed of achieving a complete cure for hepatocellular carcinoma (HCC) by replacing the liver with a new graft. Although the early results of liver transplantation for HCC were disappointing, with 5-year survival less than 40%, improved results in patients who met the so-called Milan criteria rekindled the enthusiasm for the treatment of HCC with liver transplantation. Furthermore, the recent development of living-donor liver transplantation in adults has allowed timely grafting for HCC patients and tentative expansion of the criteria for transplant candidacy in patients with HCC — although such expansion is fraught with controversy. Identification of a noninvasive marker that could predict the biological behavior as well as the prognosis of HCC would indeed be a major breakthrough.     

Living-donor kidney transplantation: the Freiburg experience

Background and aim The objective of this study was to determine outcome after living-donor kidney transplantation in a single-center institution in Germany. Materials and methods From 1976 to May 2005, a total of 298 living-donor kidney transplants were performed at the University of Freiburg. Most recipients (78.8%) were placed on cyclosporine, mycophenolate mofetil, and corticosteroids maintenance immunosuppression. Cox proportional hazard model was applied to analyze predictors for patient and graft survival. Mean follow-up was 5.3 years. Results According to Kaplan–Meier calculation, 1-, 5-, and 10-year patient survival was 98.6, 92.7, and 86.8%, respectively. Kidney function rate was 95.5, 82.8, and 67.9%, respectively. A 5-year graft function rate continued to increase from 79.5% in patients transplanted before 1996 to 83.6% in patients transplanted thereafter. In a Cox regression model recipient age above 50 years, duration of dialysis above 2 years and preexisting type 1 diabetes mellitus were associated with a decreased patient survival. Graft survival was mostly influenced by the type of immunosuppression and preexisting hypertension of the recipient. Conclusions Our results demonstrate that living-donor kidney transplantation is a highly effective therapy for patients with end stage renal failure. Updates in immunosuppression, recipient selection, and operative technique may have contributed to the improved graft survival over the past three decades.     

Living-donor lobar lung transplantation for infectious lung diseases

The rate of infection among lung transplant recipients is several times higher than that among recipients of other organs and is most likely related to the exposure of the allograft to the external environment. Meticulous peri-operative management is mandatory in performing living-donor lobar lung transplantation for patients with infectious lung diseases. All 5 patients with end-stage infectious lung diseases are currently alive for 17-104 months after receiving living-donor lobar lung transplantation at Okayama University Hospital.