Living donor liver transplantation.
OBJECTIVE
The widening gap between the growing number of liver transplant candidates and the supply of deceased donor organs became a strong motivation for the development of living donor liver transplantation (LDLT). LDLT has gone through its developmental phase and become an established life-saving procedure.


RESULTS
Despite the challenging nature of the technique of LDLT, there have been continuous innovations. A better understanding of complex surgical anatomy and physiologic differences of partial hepatic allografts has helped to avoid graft congestion, small-for-size syndrome, or graft hypoperfusion from portal flow steal. LDLT for patients with high Model for End-Stage Liver Disease score can achieve comparable results with deceased donor liver transplantation (DDLT). Size limitation of partial grafts can be overcome with dual grafts. The extended application of LDLT for hepatocellular carcinoma beyond Milan criteria seems feasible but at the cost of slightly compromised survival. More information has become available for prospective donors about the consequences of living liver donation in terms of psychosocial impact.


CONCLUSIONS
Although LDLT is still evolving, it has become the most effective alternative to DDLT. Proven or potential benefit of LDLT include the superior quality of the allograft despite the smaller size, selection of proper timing for transplantation and a reduced waiting time, which prevents waiting list mortality.
Jeon
Hoonbae
H
Division of Transplant, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Lee
Sung-Gyu
SG
D006085:Graft Survival; D006439:Hemodynamics; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008102:Liver Circulation; D008107:Liver Diseases / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D019520:Living Donors / Q000600:supply & distribution*; D019060:Minimally Invasive Surgical Procedures; D055031:Primary Graft Dysfunction / Q000209:etiology / Q000503:physiopathology; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014850:Waiting Lists