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Indications to LDLT: a changing pathway?

Stefano Di Sandro1,2, Deniz Balci3, Fabrizio Di Benedetto4,5

  • 1Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy. stefano.disandro@unimore.it.

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|April 8, 2024
PubMed
Summary
This summary is machine-generated.

Living donor liver transplantation (LDLT) outcomes have improved with better recipient selection and surgical techniques. LDLT is increasingly vital in liver tumor treatment, offering survival benefits over other options.

Keywords:
Colo-rectal liver metsatsesHepatocellular carcinomaLiving donor liver transplantationTransplant oncology

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Area of Science:

  • Hepatology
  • Transplant Surgery
  • Surgical Oncology

Background:

  • Liver transplantation (LT) offers a cure for cirrhosis, with over 80% survival at 5 years.
  • Cirrhosis, with or without hepatocellular carcinoma (HCC), is the main reason for LT.
  • Living donor liver transplantation (LDLT) initially had poorer outcomes but has improved significantly.

Purpose of the Study:

  • To review the advancements and evolving role of LDLT.
  • To highlight LDLT's increasing importance in transplant oncology.
  • To discuss the impact of recipient selection and surgical innovations on LDLT outcomes.

Main Methods:

  • Review of studies on LDLT outcomes and indications.
  • Analysis of recipient selection criteria and donor/recipient matching.
  • Evaluation of emerging techniques like the RAPID technique and minimally invasive approaches.
  • Assessment of LDLT's role in treating liver tumors, including colorectal liver metastases (CLM).

Main Results:

  • LDLT outcomes have improved through precise recipient selection and donor/recipient matching.
  • Advanced techniques like left lobe preference and minimally invasive approaches enhance LDLT success.
  • The RAPID technique shows promise for both cirrhotic and non-cirrhotic livers.
  • LDLT offers better survival for liver tumors like CLM compared to alternatives, with optimal timing involving chemotherapy.

Conclusions:

  • LDLT is becoming a crucial option in liver transplantation, especially in oncology.
  • As virus-related cirrhosis declines, LDLT's role is expanding.
  • LDLT can surpass deceased donor transplants in specific oncological scenarios, improving patient survival.