[Living-related segmental liver transplantation: broadening application in adult recipients]

Living-related liver transplantation using the left lateral segment has evolved as a surgical procedure in response to the need for size-matched grafts for small children. Experience gained with this procedure over the last decade and superb results led many centers to apply similar techniques for use of the right lobe for adults. Right lobe living-related liver transplantation is advantageous mainly for patients who otherwise would have long waiting periods for cadaveric organs, such as those with cholestatic liver disease or stable cirrhotic patients with small hepatocellular carcinoma. However, it is important to remember that living donors are healthy volunteers, and the risk associated with right hepatectomy is considerably higher than the risk of left lateral segmentectomy. The estimated risk for morbidity, mainly for bile duct leaks and intra-operative blood loss is about 5%, and the risk for mortality after right lobectomy is 0.2-0.5%. Extended experience in liver resections and segmental liver transplantation techniques in children is a prerequisite before initiating an adult living-related program. In addition, use of strict criteria for donor and recipient selection may lessen the risk associated with living donor liver transplants and thus further justify its use.