Living Related Liver Transplantation

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Living Related Liver Transplantation

• Selection,
• Postoperative management and
• Long term follow up

Prof. Gamal Esmat. Professor of Hepatology and
Gastroenterology Cairo University
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• Living donor liver transplantation allows
  an increasing number of patients with end-stage
  liver disease the opportunity to have effective
  treatment.
• Liver donor liver transplantation (LDLT) is
  a procedure in which a living person donates a
  portion of his or her liver to another.

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• Despite using organs from older donors and
  donors with steatosis or evidence of current
  (e.g. hepatitis C positive) or prior (e.g.,
  hepatitis B core antibody positive) viral
  hepatitis, the number of deceased donor organs
  has increased slowly. This shortage led to a
  marked increase in adult-to-adult living donor
  transplantation from 1998 to 2001

OPTN/ SRTR Annual Report 2003
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• LDLT in both pediatric and adult recipients
  has been well established in major Asian
  transplant centers as a primary type of liver
  transplantation in Japan or as a complement to
  the markedly limited supply of cadaveric grafts
  in the rest of the region.

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Survey of Liver Transplantation from Living Adult
Donors in the United States
Robert S. Brown et al, N ENGL J MED 3489
Feb-2003
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• On August 28, 2001 we started in Dar Al Fouad
  (DAF) hospital the first adult to adult living
  Related liver transplantation in Egypt in co
  operation with Kyoto University in Japan.

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LRLT In DAF Hospital

• Why LRLT?
• Till now cadaveric Tx is not allowed in Egypt
• Advantages of LRLT
• Reduction of waiting time for recipients
• Elective surgery
• Very short ischemia time

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LRLT In Donor Evaluation
Ethical committee
CT volumetry Psychological assessment
UA, CBC, ABO, ESR, LFTs, coagulation profile,
lipid profile, BUN, S. cr., Bl. Suger, HBsAg,
Anti HBc, anti HCV, abd. US
Additional lab- Doppler US abd MRCP- MR
Angiography- Echo heart Respiratory function
Liver Bx
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Aetiology
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Lobectomy incision line marked with argon at 1
cm. from middle hepatic vein using ultrasound
guidance
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Delineation OF DISSECTION PLANE
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I.O color Doppler of hepatic veins after liver
transection
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Complications in 1508 living liver donors in Asia
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Survey of Liver Transplantation from Living Adult
Donors in the United States
Robert S. Brown et al, N ENGL J MED 3489
Feb-2003
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What about donor complications in DAFH series?
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Complications in Donors
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Complications in Donors
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Invasive Procedures
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Donor Morbidity in DAF Hospital

• One case of aborted donor hepatectomy due
  to schistosomal hepatic fibrosis,

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NO DONOR MORTALITY
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Complications Outcome of living liver donors

• Avoidance of complications
• Pre-operative evaluations
• An accurate medical and anatomical evaluation
  particularly for
• -liver volumetry
• -vascular and Biliary tree
• -correction for the degree of steatosis
• Preoperative liver biopsy

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Complications Outcome of living liver donors

• Avoidance of complications (Cont.)
• Intra-operative considerations
• Variations in Biliary tree is seen in 40 of
  donors (intra-operative Cholangiography MRCP are
  mandatory.
• Intra operative ultrasonography to identify the
  course of the hepatic veins.

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Complications Outcome of living liver donors

• Avoidance of complications (Cont.)
• Post-operative considerations
• Providing adequate calories and protein
• Correction of hypophosphatemia.
• Prophylactic measures to avoid DVT.