Living related liver donor transplantation: techniques and caution

LDLT is often performed under less than ideal circumstances, such as limited graft mass, aberrant vascular and biliary anatomy, limited sources of venous grafts, and a recipient in a state of deterioration. The margin for error is small in both recipients and donors. Every step of the surgery needs to be planned and performed in a meticulous and synchronized manner. Small errors or absences of coordination can lead to unexpected complications. In addition, use of a segmental graft requires the knowledge of the safety margin of hepatic adaptation to nonphysiologic situations for the safety of both recipient and donor. Scientific and clinical evidences for precise individualization of the tactics are still not sufficient. Further accumulation of knowledge and experience is awaited for the safest performance of this evolving surgery.