title: More than 300 consecutive living donor liver transplants a year at a single center.
abstract: BACKGROUND
  Living donor liver transplantation (LDLT) has been the first option for the patients requiring liver transplantation in East Asia because of the scarcity of cadaveric grafts. We have performed consecutively more than 300 LDLTs per year, and herein report our methods.
  
  
  METHODS
  In 1997, the first successful adult LDLTs used a left and subsequently a right lobe. However, congestion in the anterior segment of right-lobe grafts prompted us to initiate reconstruction of middle hepatic venous tributaries in 1998. Dual LDLT grafts using 2 left lobes were developed in 2000 to solve graft-size insufficiency and minimize donor risk. The indications for adult LDLT were broadened to near complete obstruction of the portal vein by application of intraoperative cine-portography and portal vein stenting in 2004. ABO-incompatible adult LDLT was initiated in 2008 to overcome the blood group barrier between recipient and donor.
  
  
  RESULTS
  With various innovations at our institution, 317 LDLTs were performed yearly in 2010 and 2011: 301 in 2010 and 298 in 2011. The most common primary diseases was hepatitis B virus-related liver cirrhosis with or without hepatocellular carcinoma (64.3%). The most common graft types were right hemiliver (82.6%). There has been no donor mortality. ABO-incompatible LDLT cases were 11.0% of the total. In-hospital mortality in 2011 was 2.5% (n = 8; adult 6, pediatric 2).
  
  
  CONCLUSIONS
  Innovations in operative techniques and perioperative care as well as dedicated team members have made it possible to perform more than 300 LDLTs per year consecutively with excellent outcomes.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: D-B
authors.initials: DB
authors.lastname: Moon
authors.forename: S-G
authors.initials: SG
authors.lastname: Lee
authors.forename: S
authors.initials: S
authors.lastname: Hwang
authors.forename: K-H
authors.initials: KH
authors.lastname: Kim
authors.forename: C-S
authors.initials: CS
authors.lastname: Ahn
authors.forename: T-Y
authors.initials: TY
authors.lastname: Ha
authors.forename: G-W
authors.initials: GW
authors.lastname: Song
authors.forename: D-H
authors.initials: DH
authors.lastname: Jung
authors.forename: G-C
authors.initials: GC
authors.lastname: Park
authors.forename: J-M
authors.initials: JM
authors.lastname: Namkoong
authors.forename: H-W
authors.initials: HW
authors.lastname: Park
authors.forename: Y-H
authors.initials: YH
authors.lastname: Park
authors.forename: C-S
authors.initials: CS
authors.lastname: Park
mesh_terms: D000328:Adult; D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors; D056910:Republic of Korea