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Evolving surgical approaches in liver transplantation
Henrik Petrowsky1, Ronald W Busuttil
1The Dumount-UCLA Transplant Center, Ronald-Reagan UCLA Medical Center, Los Angeles, California, USA.
Seminars in Liver Disease
|February 25, 2009
Summary
To address donor liver shortages, surgical innovations like partial liver grafts from living or deceased donors are crucial. Ensuring adequate graft volume prevents complications, making these techniques vital for liver transplantation success.
Area of Science:
- Hepatology
- Transplant Surgery
- Organ Donation
Background:
- Increasing demand for liver transplants exceeds donor availability.
- This necessitates innovative surgical strategies to expand the donor pool.
- Partial liver grafts are a key strategy to utilize available donor organs.
Purpose of the Study:
- To review evolving surgical approaches in liver transplantation.
- To highlight techniques for expanding the donor pool, including partial grafts.
- To emphasize the importance of minimal viable graft volume to prevent complications.
Main Methods:
- Living donor liver transplantation (LDLT) using partial grafts.
- Split liver transplantation (SLT) creating two grafts from one donor liver.
- Auxiliary liver transplantation, preserving native liver function.
Main Results:
- LDLT is a primary option in Asia and an adjunct option globally.
- SLT commonly involves dividing the liver into pediatric and adult grafts.
- Auxiliary transplantation serves as a bridging strategy for liver regeneration.
Conclusions:
- Partial liver grafts are essential for expanding donor pool in liver transplantation.
- Maintaining adequate graft volume (0.8-1% of body weight) is critical for graft survival.
- Emerging methods like xenotransplantation and cell-based therapies show future promise.
