One hundred nine living donor liver transplants in adults and children: A single-center experience

Objective To summarize the evolution of a living donor liver transplant pro gram and the authors' experience with 109 cases. Summary Background Data The authors' institution began to offer living dono r liver transplants to children in 1993 and to adults in 1998. Methods Donors were healthy, ages 18 to 60 years, related or unrelated, and ABO-compatible (except in one case). Donor evaluation was thorough. Liver biopsy was performed for abnormal lipid profiles or a history of significan t alcohol use, a body mass index more than 28, or suspected steatosis. Imag ing studies included angiography, computed tomography, endoscopic retrograd e cholangiopancreatography, and magnetic resonance imaging. Recipient evalu ation and management were the same as for cadaveric transplant. Results After ABO screening, 136 potential donors were evaluated for 113 re cipients; 23 donors withdrew for medical or personal reasons. Four donor su rgeries were aborted; 109 transplants were performed. Fifty children (18 ye ars or younger) received 47 left lateral segments and 3 left lobes; 59 adul ts received 50 right lobes and 9 left lobes. The average donor hospital sta y was 6 days. Two donors each required one unit of banked blood. Right lobe donors had three bile leaks from the cut surface of the liver; all resolve d. Another right lobe donor had prolonged hyperbilirubinemia. Three donors had small bowel obstructions; two required operation. All donors are alive and well. The most common indications for transplant were biliary atresia f n children (56%) and hepatitis C in adults (40%); 35.6% of adults had hepat ocellular carcinoma. Biliary reconstructions in all children and 44 adults were with a Roux-en-Y hepaticojejunostomy; 15 adults had duct-to-duct anast omoses. The incidence of major vascular complications was 12% in children a nd 11.8% in adult recipients. Children had three bile leaks (6%) and six (1 2%) biliary strictures. Adult patients had 14 (23.7%) bile leaks and 4 (6.8 %) biliary strictures. Patient and graft survival rates were 87.6% and 81%, respectively, at 1 year and 75.1% and 69.6% at 5 years. In children, patie nt and graft survival rates were 89.9% and 85.8%, respectively, at 1 year a nd 80.9% and 78% at 5 years. In adults, patient and graft survival rates we re 85.6% and 77%, respectively, at 1 year. Conclusion Living donor liver transplantation has become an important optio n for our patients and has dramatically changed our approach to patients wi th liver failure. The donor surgery is safe and can be done with minimal co mplications. We expect that living donor liver transplants will represent m ore than 50% of our transplants within 3 years.