Revolution and refinement of surgical techniques for living donor partial liver transplantation

Living donor liver transplantation (LDLT) was first successfully performed on a child in 1990 and the Shinshu group performed the same procedure on an adult for the first time in 1994. Over the past few years adult LDLT has been increasing worldwide because of the severe shortage of cadaveric organs, especially in locations where the transplantation of organs from brain-dead donors is rarely practiced. The surgical procedures for LDLT are more technically challenging than those for cadaveric whole liver transplantation. LDLT requires a full understanding of hepatobiliary anatomy and continuous technical refinement of the procedure. The development of innovative techniques is a key factor for a successful LDLT. Some of the technical highlights include selective vascular occlusion techniques for donor hepatectomy, hepatic arterial reconstruction under the microscope, the introduction of intraoperative ultrasound, graft volume estimation, hepatic venous reconstruction using cryopreserved vascular grafts, and the use of the right lateral sector of the liver. These techniques have improved the success rate of LDLT over the past few years. This review focuses on the surgical techniques for LDLT on the basis of our experience with adult LDLT at the Tokyo University Hospital.