Anaesthesia for living-donor liver transplantation

In Japan, living-donor liver transplantation has long been the only solution for end-stage liver disease. During the past 10 years, 526 cases of living-donor liver transplantation have been performed at Kyoto University Hospital. This report reviews the authors experience of anaesthesia. The most important issue is the safety of the donor. As the percentage of adult recipients has increased, so has the age of donors and because risk for the donor increases with age, careful preoperative evaluation of the donor by the anaesthetist is needed. The principal differences between living-donor liver transplantation and cadaveric donor liver transplantation are surgical technique (the former is always a partial liver transplantation) and viability of the graft (should always be better with a living donor). The major problems concerning the intraoperative management of recipients in living-donor liver transplantation are how to deal with massive blood loss and postreperfusion syndrome.