L/I‐9 Adult living donor liver transplants: Niguarda experience in Milan

Abstract

Introduction: Adult living donor liver transplants (ALDLTs) have emerged as an option in the last few years.Materials and methods: From March 2001 through February 2006, we performed 27 ALDLTs. Liver volume, vascular, and biliary anatomy were assessed by CT scan and magnetic resonance cholangiography. The graft‐to‐recipient weight ratio was always above 0.8. The recipients were United Network for Organ Sharing (UNOS) status 2B or 3. The transplant was carried out grafting segments V‐VIII to the recipient without the MHV. In the recipient we have never used a venous‐venous bypass.Results: With a mean follow‐up of 675 days (range, 8 to 1,804 days), 23 out of the 27 patients are alive. Three have undergone a retransplant: 2 as a consequence of an arterial thrombosis and 1 because of small‐for‐size‐syndrome.These data show an overall patient and graft survival rate of 85% and 74%. Four deaths were caused by massive pulmonary bleeding due to Rendù‐Osler syndrome, systemic aspergillosis, sepsis, and cardiac arrhythmia. Fourteen biliary complications (51.85%) occurred in 11 recipients (40.74%); 3 of these patients developed 2 consecutive and different biliary complications. All the donors are alive and well.Conclusion: An expert surgical team and proper selection of both donor and recipient are mandatory. Overall results of ALDLTs are very satisfactory, even if we have to take into account a high rate of biliary complications.