Adult-to-adult live donor liver transplantation: A short-term clinicopathologic study

With the success of pediatric live donor liver transplantation (LDLT) and t he continued shortage of cadaveric donors, adult-to-adult LDLT has been per formed at some centers, including ours. We performed a detailed histologic review of all liver specimens obtained from 9 adult recipients at and after LDLT and correlated these findings with the patients' course and outcome. Five patients had histologic evidence of biliary tract pathology; 3 of 5 re quired surgical or radiologic intervention. The other 2 had clinically insi gnificant biliary disease. Diffuse hepatocytic hemorrhagic necrosis seconda ry to massive portal blood flow after portal venous revascularization resul ted in graft failure and retransplantation in a single patient with severe preoperative portal hypertension. Two perioperative deaths were caused by s epsis and multiorgan failure (day 25) and generalized thrombosis related to factor V Leiden (day 6). The preoperative diagnosis, presence of portal ve in thrombosis in the native liver, postoperative cholangiopathy, and subcap sular hemorrhagic necrosis in donor liver wedge biopsies did not affect the short-term outcome. In conclusion, biliary tract pathology is common after adult-to-adult LDLT but does not negatively affect graft or patient surviv al. Infrequent but catastrophic vascular complications related to portal he modynamics or thrombosis can result in graft loss and/or patient death. HUM PATHOL 32:814-822. (C) 2001 by W.B. Saunders Company.