NEW TECHNIQUES FOR LIVER-TRANSPLANTATION - REDUCED-SIZE, SPLIT-LIVER,LIVING-RELATED AND AUXILIARY LIVER-TRANSPLANTATION

Mortality among patients on a waiting list for orthotopic liver transp lantation continues to be 10-15%; this is of particular concern in the pediatric population and may become more problematic in adult patient s as longer waiting lists for cadaveric transplantation accrue. The lo nger cold ischemia times afforded by use of University of Wisconsin (U W) solution and improved hepatic surgery techniques have allowed the d evelopment of reduced-size liver transplantation (RSLT), split-liver t ransplantation (SLT), and living-related liver transplantation (LRLT). These new surgical techniques have been predominantly employed in chi ldren, up to 40% of whom may be candidates for one of these modified p rocedures. With the exception of SLT, these approaches have been assoc iated with comparable rates of biliary tract and vascular complication s, rejection episodes and graft and patient survival when compared to whole organ transplantation. Right hepatic lobe graft recipients have approximately 15% decreased graft survival rates, limiting the accepta nce of SLT as a standard approach to decrease waiting List limes. Appl ication of LRLT to the adult population, where 5-10% of recipients are potential candidates, is expected to increase. Over 100 LRLTs have be en performed worldwide and while recipient survival with LRLT is excel lent, concerns about donor morbidity and mortality, psychosocial facto rs and reimbursement issues remain obstacles. Living-unrelated liver t ransplantation and auxiliary orthotopic partial liver transplantation are developing approaches to be considered only in highly selected cas es.