Start of an adult living-donor liver transplantation programme in Switzerland

The shortage of cadaver organs has prompted transplant centres to seek new sources of grafts. While living-donor left lobe transplantation (segments I I and III) is an established procedure for children, living donor right liv er transplantation (segments V, VI, VII, VIII), which can provide adequate liver mass for an average-sized adult patient, is technically more demandin g and potentially associated with higher risks for the donor. In view of th e permanent shortage of organs in Switzerland, we started an adult living d onor liver transplantation programme in 1999 with the approval of the Clini cal Ethics Committee of Geneva University Hospitals. Donor evaluation was p er formed only after the recipient had been officially registered for trans plantation in the national waiting list. Preoperative evaluation consisted of a preliminary information phase with blood tests and Doppler ultrasonogr aphy, a second phase with radiological non invasive investigations (CT scan with volume measurements, magnetic resonance cholangiography) and a third phase including liver biopsy and angiography. A formal psychiatric evaluati on was performed in all cases and detailed consent was required. Eight pote ntial donors were investigated, 5 were not retained because of too small ri ght liver or steatosis, and 3 were accepted (wife, son, sister). Living-don or hepatectomy was performed without interrupting the vascular blood flow. The liver graft was perfused ex-situ with University of Wisconsin solution. The grafts were anastomosed to the preserved vena cava of the recipient an d the portal and arterial anastomoses were performed without interposition grafts, with short cold ischaemic times in the 3 cases. The graft-to-recipi ent weight ratio ranged from 1.04 to 1.12%. The grafts worked immediately; the post-operative course in the 3 recipients was unremarkable and no rejec tion episode occurred. Significant complications were observed in one donor (percutaneously drained bilioma and spontaneously resolved popliteal senso ry palsy). Living-donor right liver transplantation is a potentially valuable solution to the increasing shortage of donor organs. The procedure can be performed safely provided stringent criteria for donor selection, for donor-recipien t coupling (>1% graft to body weight ratio) and for centre selection (exper ience in liver surgery, reduced and split liver transplantation) are applie d.