Primary Living-Donor Liver Transplantation at the University of Chicago: Technical Aspects of the First 104 Recipients

Clinical liver transplantation was originally described and performed on children. 1 However, because of the low prevalence of disease that progresses to end-stage liver disease, a shortage of organs appropriate for pediatric transplantation, and the lack of surgical expertise, the accumulated experience in pediatric liver transplantation is significantly less than in adult liver transplantation. Living-donor liver transplantation was first reported by Raia et al in 1989 2 and by Strong et al in 1990. 3 To expand the donor pool and thus allow timely transplantation of children with end-stage liver disease, the University of Chicago instituted the first prospective systematic application of living-donor liver transplantation in 1989. 4 Since then, we have performed more than 100 such transplants. The experience at the University of Chicago accounts for almost 50% of the living-donor liver transplants performed in the United States during this period. After the successful reports from Australia and Chicago in 1992, the use of living-donor liver transplantation has gained widespread acceptance for the treatment of children with liver disease, especially in Japan, where it has supplied most of the grafts for liver transplantation. 5–14 The advent of this procedure was accompanied by several new technical challenges in an already technically demanding field. As with most innovative advances, subsequent modifications have been made in an attempt to resolve unforeseen complications. 15 At the University of Chicago, we have defined various phases of the living-donor liver transplant program by the technical modifications of the recipient operation. These modifications affect the performance of living-donor transplants and the growing number of split-liver transplants being performed. We analyzed the first 104 living-donor liver transplants performed at the University of Chicago from November 1989 to January 1998, with particular focus on the technical conduct of the operation, to identify factors important to a favorable outcome.