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Published on: August 17, 2022
Living donor liver transplantation in polycystic liver disease
Kristin L Mekeel1, Adyr A Moss, Kunam S Reddy
1Division of Transplantation, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA. mekeel.kristin@mayo.edu
Insights
Living donor liver transplantation (LDLT) offers a viable solution for patients with polycystic liver disease (PCLD) and preserved liver function. This approach avoids caval resection, enabling successful transplantation and improving quality of life.
Area of Science:
- Hepatology
- Transplantation Surgery
- Genetics
Background:
- Polycystic liver disease (PCLD) causes massive hepatomegaly, severely impacting patient quality of life.
- Current transplant criteria disadvantage PCLD patients with preserved liver function.
- Traditional caval resection is complex and precludes living donation.
Purpose of the Study:
- To evaluate the feasibility and outcomes of caval-sparing hepatectomy followed by living donor liver transplantation (LDLT) in PCLD patients.
- To assess graft and patient survival rates and complication incidence.
- To establish LDLT as a viable alternative for PCLD management.
Main Methods:
- Retrospective case series of 3 PCLD patients undergoing caval-sparing hepatectomy and LDLT.
- Detailed analysis of surgical procedures, perioperative care, and long-term follow-up.
- Assessment of graft function and patient survival post-transplantation.
Main Results:
- 100% graft and patient survival observed in all 3 cases.
- No major complications reported for donors or recipients.
- Successful management of massive hepatomegaly while preserving liver function.
Conclusions:
- Caval-sparing hepatectomy followed by LDLT is a safe and effective treatment for PCLD patients.
- LDLT provides an excellent option for PCLD patients with preserved liver function and poor quality of life.
- This approach overcomes limitations of deceased donor transplantation and traditional surgical methods.
Abstract:
In the current Model for End-Stage Liver Disease system, patients with polycystic liver disease (PCLD) who have a poor quality of life secondary to their massive hepatomegaly are no longer competitive for a deceased donor liver transplant if their liver function is well preserved. Traditionally, a caval resection has been advocated in these patients because of the difficulty of the hepatectomy with hepatomegaly, which makes living donation impossible. This series looks at 3 patients who underwent a caval sparing hepatectomy and subsequent living donor liver transplantation (LDLT) for PCLD. Graft and patient survival was 100%, and there were few complications in either donors or recipients. LDLT is an ideal option for patients with PCLD and preserved liver function but poor quality of life.
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