Living donor liver transplantation and hepatitis C.

Abstract

Adult-to-adult right hepatic lobe living donor liver transplantation (LDLT) is a treatment option for selected patients with end-stage liver disease. The development of LDLT is due in large part to the critical shortage of donor organs. Currently, the number of patients listed for liver transplantation exceeds the cadaveric organ supply by nearly four-fold. In 2001 there were 5177 liver transplants performed, but by the end of the year, there were still 18,537 patients on the liver transplant waiting list. As a result, 11% of listed patients died on the waiting list that year [1]. The organ shortage has led to the development of new techniques to expand the donor pool. These include the use of marginal cadaveric organs, split liver transplantation, and LDLT. The first LDLT was performed in 1988 [2]. Subsequently, the procedure was developed in Asia where cultural beliefs proscribe the use of cadaveric donors for transplantation. In the early 1990s, LDLT was introduced in the United States where almost all of the recipients were children. Typically, the left lobe (which is smaller than the right lobe) or one or more of its segments is removed, usually from a parent, and transplanted into the child. Early attempts of adult-to-adult left hepatic lobe LDLT in the United States were oftentimes unsuccessful because the left hepatic lobe did not provide sufficient hepatic mass for an adult recipient. The first right hepatic lobe LDLT was reported in 1994 [3] and the first adult-to-adult right hepatic lobe LDLT in the United States was performed at the University of Colorado in 1997 and reported in 1998 [4]. Outcomes with transplantation of the larger right hepatic lobe in adults were superior to left hepatic lobe LDLT. The initial success of right hepatic lobe LDLT, coupled with the critical cadaveric organ shortage, led to a dramatic increase in LDLT between 1997 and 2001 as shown in Fig. 1 [1].