Living-Donor Liver Transplantation in Taiwan

Abstract

Living-donor liver transplantation (LDLT) is currently the only effective means to significantly increase the graft supply in societies where cadaveric donation is very limited, as in Taiwan. Since the Kaohsiung Chang Gung Memorial Hospital (CGMH) Liver Transplant Program commenced in 1993, as a continuation of the pioneering program in Linkou CGMH in 1984, we have performed a total of 94 liver transplants for pediatric and adult recipients, 57 of which were with grafts from living donors. Forty-eight of the LDLTs were left-side grafts and nine were right-side grafts. Donor hepatectomies were performed with minimal blood loss and no blood transfusions, which led to prompt recovery and eliminated the risk of transfusion-related disease. Multiple and smaller caliber vessels or ducts are major technical challenges in LDLT. Twelve grafts (21%) had multiple hepatic veins, 22 (39%) had multiple hepatic arteries, and 19 (33%) had multiple bile ducts. Significant technical complications included two hepatic outflow problems, four portal vein problems, and six biliary problems. There was no hospital mortality, but one patient developed septic shock after a radiological procedure and died 4 months after the transplant. The actual patient and graft survival rates were 98.2%. Careful patient selection, judicious preoperative evaluation, meticulous surgical techniques, and prompt detection and management of complications all contribute to optimizing outcomes in LDLT.