Partial liver transplantation

Since the introduction of the split-liver transplantation procedure 15 years ago a variety of partial liver transplantations have been developed. The earliest form of split-liver transplantation consisted of reduction of a whole liver graft to just the left lateral segment or the left liver lobe, which was then small enough to transplant to a young child. The rest of the liver was discarded. This method partially solved the great need for liver grafts for children but as the remaining part of the liver was discarded the method was in fact detrimental for adults on the waiting list. Further surgical development resulted in splitting of the liver ex vivo into two transplantable partial grafts: the left part to a child and the right lobe to an adult. This procedure was successfully introduced but the complicated logistics resulted in prolonged cold ischemia times for the grafts. In order to keep the cold ischemia time as short as possible, the in situ split-liver technique was developed, in which the liver was split in the post-mortem donor. Refinement of this operation led to results which were superior to those obtained with the ex vivo method; moreover, it opened the door to living-donor liver transplantation. The first successful procedure was performed from a mother to a child, who received the mother's left liver segment. The introduction of this technique resulted over the years in a decrease in the pediatric waiting list to almost zero. As the demand for organs increases every year and the number of donors remains constant in Western countries, the right-lobe living-donor liver transplantation for adults has been introduced. Introduction of all forms of partial liver transplantation has relieved the pressure on waiting lists, especially for children but also for adults. There are, however, serious concerns regarding the high morbidity and mortality rates associated with the living-donor donation procedure.