Initial experience with urgent adult-to-adult living donor liver transplantation in fulminant hepatic failure.
BACKGROUND
The prognosis of patients with fulminant hepatic failure without timely liver transplantation is dismal. Given the limited availability of cadaveric organs for urgent transplantation in Israel, adult-to-adult living donor segmental liver transplantation may be the only alternative.


OBJECTIVE
To report our initial experience with urgent lifesaving LDLT in this unique scenario.


METHODS
Three adult patients with FHF (two of unknown etiology, one with paracetamol intoxication) were transferred from other institutions and admitted to our intensive care unit. Initial treatment and monitoring included intracranial pressure monitoring and hepatic dialysis using the Molecular Adsorbent Recirculating System. Expeditious potential donor selection included medical, psychosocial and surgical evaluation. Liver volume and vascular anatomic compatibility were assessed with computed tomography angiography.


RESULTS
Between July and October 2003 we performed three procedures of urgent adult-to-adult LDLT. The donors (two uncles, one sister) underwent hepatic resection (two right lobes, one left lateral segment) and recovered well. The recipients underwent total hepatectomy with caval preservation, followed by lobar grafting. All recipients recovered and are alive with good liver function and without any neurologic complications.


CONCLUSIONS
Urgent adult-to-adult living donor segmental liver transplantation can be performed safely and timely as a lifesaving procedure in the setting of comatose patients with FHF.
Department of Surgery B, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Nir
N
Lubezky
Richard
R
Nakache
Michal
M
Carmiel
Ran
R
Oren
Patrick
P
Sorkine
Joseph
J
Klausner
Menahem
M
Ben-Haim
D000293:Adolescent; D000328:Adult; D005260:Female; D006084:Graft Rejection; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D016896:Treatment Outcome