Adult to adult living donor liver transplantation for decompensated end-stage liver disease

Objective To summarize the clinical experience and some principal surgical techniques of adult to adult living donor liver transplantation (ALDLT). Methods The clinical data of 9 patients receiving ALDLT from September 2000 to September 2004 in liver transplantation center in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. The left lobe (segments Ⅱ, Ⅲ, Ⅳ, including the middle hepatic veins) was transplanted in 3 patients, and the right lobe (segments Ⅴ, Ⅵ, Ⅶ, Ⅷ, not including the middle hepatic veins) was transplanted in 6 patients. Results There was no operative death in donors . The median operative time was (6.2±1.4) hours. The blood loss ranged from 300 to 1 200 ml . Postoperative complications included biliary fistula (1 donor) and wound fat liquefaction ( 1 donor ). They were followed up for 612 months, and no long-term complications were found. In recipients , the operating time ranged from 5 to 11 hours. The blood loss ranged from 800 to 7 000 ml. Modified outflow reconstruction method, microvascular reconstruction of the hepatic artery and duct-to-duct biliary reconstruction were performed in recipients. The median cold ischemic time of the grafts was (1.9±0.5) hours . The mean non hepatic stage of recipients was (98±26) minutes. Graft/recipient weight ratio (GRWR) was (1.20±0.26)%. One recipient presented postoperative complication of biliary fistula . One recipient died of serious infection 1 month postoperatively. The other 8 recipients enjoyed long-term survival . Conclusion The procedure of ALDLT is an effective method in the treatment of decompensated end-stage liver disease, and it is relatively safe for the donor. Reconstruction of vessels is the key surgical technique in the operative procedure.