Living-donor liver transplantation in children

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%.