Living donor liver transplantation for acute liver failure: a single center experience.
OBJECTIVE
Orthotopic liver transplantation (OLT) is the principal therapy for acute liver failure (ALF). The mortality on the waiting list for deceased donor liver transplantation (DDLT) is high, principally in countries where donation rates are low. Living donor liver transplantation (LDLT) seems an option for the treatment of ALF, although some ethical issues need to be considered. Herein we have evaluated LDLT results among patients with ALF and discussed the ethical aspects of procedures performed in emergency situations.


METHODS
From March 2002 to October 2008, we performed 301 liver transplantations, including 103 from living donors. ALF was responsible for 10.6% of all transplantations; LDLT was only considered for pediatric recipients among whom 7 children displayed ALF.


RESULTS
One patient died on postoperative day 33 due to hepatic artery thrombosis. One patient died at 2 months after transplantation due to biliary sepsis, resulting in an overall survival rate of 71%. The average time for donor discharge was 5 days. No mortality or major complications were observed.


CONCLUSIONS
The survival of children with ALF undergoing LDLT was comparable to published data. Furthermore, despite the fact that the available time to prepare the donors was limited, no serious complications were observed in the postoperative period. Thus, using living donors for children with ALF is an effective, safe alternative that can be extremely useful in countries with low donation rates.
Liver Transplantation Unit, Bonsucesso General Hospital, Rio de Janeiro, Brazil.
L P
LP
Cariús
L F
LF
Pacheco-Moreira
E
E
Balbi
C R G
CR
Leal
A C
AC
Gonzalez
L V
LV
Agoglia
C
C
Araújo
M
M
Enne
J M
JM
Martinho
D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D017114:Liver Failure, Acute / Q000601:surgery*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*; D019520:Living Donors; D008297:Male; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors