Orthotopic liver transplantation and living donors. An experimental study in the dog

Orthotopic liver transplantation (OLT) using partial grafts harvested from living donors would represent a further alternative to the limited supply of hepatic grafts, especially in pediatrics. We report herein the results of an original technique of living donor OLT that we have developed in the dog. This study was conducted in male mongrel dogs weighing 25-30 kg for the donors and 10-15 kg for the recipients. The donor operation consisted in harvesting the left lobe of the liver as a graft. The recipient operation consisted in the implantation of the graft in the orthotopic position after total hepatectomy with preservation of the inferior vena cava. Ten survival experiments were undertaken. The first donor died of infected liver necrosis of the quadrate lobe. All other donors survived without major complication. Among the 10 grafts, only 9 were used. Substantial survival could be obtained in 3 dogs. On recipient survived for 48 hours and 2 for 24 hours but their graft was functioning and producing bile. Two dogs died intraoperatively. The 4 other recipients developed an outflow block of the graft after reperfusion leading to lethal hemorrhage from the transected surface. This work is, to our knowledge, the first experimental study of OLT using living donors. It provides a technical basis to the clinical use of living hepatic allograft donors which otherwise depends on ethical issues.