title: Living donor liver transplantation.
abstract: OBJECTIVE
  Living donor liver transplantation (LDLT) continues to evolve, generating interesting issues on the applicability and safety of new techniques.
  
  
  RESULTS
  Specific selection criteria and standardized surgical techniques with high ethical and medical standards are needed to minimize donor risk. In this aspect, minimally invasive donor hepatectomy has caused controversies. The reproducibility and safety of pure laparoscopic major hepatectomy in LDLT remains uncertain. Therefore, a stepwise approach is needed to avoid unnecessary donor risk. To expand the living donor pool, dual graft and ABO-incompatible LDLT have emerged as well tolerated and effective methods. The extended selection criteria for hepatocellular carcinoma in LDLT appear acceptable to balance donor risk and recipient outcome. However, these criteria should be validated based on the risk-benefit ratio. Despite technical advances, technical challenges persist such as Budd-Chiari syndrome and portal vein thrombosis. To address these issues, several innovative surgical techniques have been proposed and have shown promising results.
  
  
  CONCLUSIONS
  LDLT is associated with donor safety concerns, technical complexity, and small-for-size issues. Nonetheless, accumulated experience and technical know-how from large-volume Asian LDLT centers have led to progress in LDLT. Further technical refinement and investigation to overcome the disadvantages of partial grafts will broaden the applicability of LDLT.
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: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D046148:Donor Selection; D006498:Hepatectomy / Q000379:methods; D006648:Histocompatibility; D006801:Humans; D008107:Liver Diseases / Q000097:blood / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D015203:Reproducibility of Results
chemical_list: D000017:ABO Blood-Group System