Partial liver transplantation

Abstract

Partial liver transplantation, including reduced-size liver transplantation, split liver transplantation, and living donor liver transplantation, has been developed with several innovative techniques because of donor shortage. Reduced-size liver transplantation is based on Couinaud’s anatomical classification, benefiting children and small adult recipients but failing to relieve the overall donor shortage. Split liver transplantation provides chances to two or even more recipients when only one liver graft is available. The splitting technique must follow stricter anatomical and physiological criteria either ex situ or in situ to ensure long-term quality. The first and most important issue involving living donor liver transplantation is donor safety. Before surgery, a series of donor evaluations—including anatomical, liver volume, and liver function evaluations—is indispensable, followed by ethnic agreement. At different recipient conditions, auxiliary liver transplantation and auxiliary partial orthotopic liver transplantation, which employ piggyback techniques, are good alternatives. Partial liver transplantation enriches the practice and knowledge of the transplant society.

Keywords

partial liver transplantation / reduced-size liver transplantation / split liver transplantation / living donor liver transplantation

References

[1] Marwan I K, Fawzy A T, Egawa H, Inomata Y, Uemoto S, Asonuma K, Kiuchi T, Hayashi M, Fujita S, Ogura Y, Tanaka K. Innovative techniques for and results of portal vein reconstruction in living-related liver transplantation. Surgery, 1999, 125(3): 265-270

[2] Bismuth H, Houssin D. Reduced-sized orthotopic liver graft in hepatic transplantation in children. Surgery, 1984, 95(3): 367-370

[3] Couinaud L.etudes Anatomiques et Chirurgicales. 1957

[4] de Ville de Goyet J, Hausleithner V, Reding R, Lerut J, Janssen M, Otte J B. Impact of innovative techniques on the waiting list and results in pediatric liver transplantation. Transplantation, 1993, 56(5): 1130-1136

[5] Langnas A N, Marujo W C, Inagaki M, Stratta R J, Wood R P, Shaw B W Jr. The results of reduced-size liver transplantation, including split livers, in patients with end-stage liver disease. Transplantation, 1992, 53(2): 387-390

[6] Burgos L, Hernández F, Barrena S, Andres A M, Encinas J L, Leal N, Gamez M, Murcia J, Jara P, Lopez-Santamaria M, Tovar J A. Variant techniques for liver transplantation in pediatric programs. Eur J Pediatr Surg, 2008, 18(6): 372-374

[7] Pichlmayr R, Ringe B, Gubernatis G, Hauss J, Bunzendahl H. Transplantation of a donor liver to 2 recipients (splitting transplantation)- a new method in the further development of segmental liver transplantation. Langenbecks Arch Chir, 1988, 373(2): 127-130

[8] Bismuth H, Morino M, Castaing D, Gillon M C, Descorps Declere A, Saliba F, Samuel D. Emergency orthotopic liver transplantation in two patients using one donor liver. Br J Surg, 1989, 76(7): 722-724

[9] de Ville de Goyet J. Technique for ex situ cadaveric liver division. In: Rogiers X, Bismuth H, Busuttil R W, Broering D C, Azoulay Deds. Split Liver Transplantation. Darmstadt: Springer, 2002: 75.

[10] Rogiers X, Malago M, Habib N, Knoefel W T, Pothmann W, Burdelski M, Meyer-Moldenhauer W H, Broelsch C E. In situ splitting of the liver in the heart-beating cadaveric organ donor for transplantation in two recipients. Transplantation, 1995, 59(8): 1081-1083

[11] Rogiers X, Malagó M, Gawad K, Jauch K W, Olausson M, Knoefel W T, Gundlach M, Bassas A, Fischer L, Sterneck M, Burdelski M, Broelsch C E. In situ splitting of cadaveric livers. The ultimate expansion of a limited donor pool. Ann Surg, 1996, 224(3): 331-341

[12] Yersiz H, Renz J F, Farmer D G, Hisatake G M, McDiarmid S V, Busuttil R W. One hundred in situ split-liver transplantations: a single-center experience. Ann Surg, 2003, 238(4): 496-505

[13] Noujaim H M, Gunson B, Mayer D A, Mirza D F, Buckels J A, Candinas D, McMaster P, de Ville de Goyet J. Worth continuing doing ex situ liver graft splitting? A singlecenter analysis. Am J Transplant, 2003, 3(3): 318-323

[14] Raia S, Nery J R, Mies S.Liver transplantation from live donors. 1989, 2(8661):497

[15] Strong R W, Lynch S V, Ong T H, Matsunami H, Koido Y, Balderson G A. Successful liver transplantation from a living donor to her son. N Engl J Med, 1990, 322(21): 1505-1507

[16] Tanaka K, Uemoto S, Tokunaga Y, Fujita S, Sano K, Nishizawa T, Sawada H, Shirahase I, Kim H J, Yamaoka Y, Ozawa K. Surgical techniques and innovations in living related liver transplantation. Ann Surg, 1993, 217(1): 82-91

[17] Testa R, Caglieris S, Risso D, Arzani L, Campo N, Alvarez S, Giannini E, Lantieri P B, Celle G. Monoethylglycinexylidide formation measurement as a hepatic function test to assess severity of chronic liver disease. Am J Gastroenterol, 1997, 92(12): 2268-2273

[18] Cescon M, Grazi G L, Del Gaudio M, Ercolani G, Ravaioli M, Nardo B, Cavallari A. Outcome of right hepatectomies in patients older than 70 years. Arch Surg, 2003, 138(5): 547-552

[19] Urata K, Kawasaki S, Matsunami H, Hashikura Y, Ikegami T, Ishizone S, Momose Y, Komiyama A, Makuuchi M. Calculation of child and adult standard liver volume for liver transplantation. Hepatology, 1995, 21(5): 1317-1321

[20] Tanaka K, Ogura Y. “Small-for-size graft” and “small-for-size syndrome” in living donor liver transplantation. Yonsei Med J, 2004, 45(6): 1089-1094

[21] Kobayashi S, Ochiai T, Hori S, Suzuki T, Shimizu T, Gunji Y, Shimada H, Kanazawa M, Ogawa A, Kohno Y, Hirasawa H, Oda S, Tanaka K. Complete recovery from fulminant hepatic failure with severe coma by living donor liver transplantation. Hepatogastroenterology, 2003, 50(50): 515-518

[22] Tanaka A, Tanaka K, Shinohara H, Hatano E, Sato S, Kanazawa A, Kitai T, Higashiyama H, Nakamura Y, Yamamoto Y, Okajima H, Egawa H, Ikai I, Uemoto S, Satomura I, Ozaki N, Inomata Y, Yamaoka Y. Extension of the indication for living related liver transplantation from children to adults based on resolution of graft size mismatch in relation to tissue oxygenation and metabolic load: a case report. Transpl Int, 1996, 9(Suppl 1): S174-S177

[23] Lo C M, Fan S T, Liu C L, Lo R J, Lau G K, Wei W I, Li J H, Ng I O, Wong J. Extending the limit on the size of adult recipient in living donor liver transplantation using extended right lobe graft. Transplantation, 1997, 63(10): 1524-1528

[24] Lo C M, Fan S T, Liu C L, Chan J K, Lam B K, Lau G K, Wei W I, Wong J. Minimum graft size for successful living donor liver transplantation. Transplantation, 1999, 68(8): 1112-1116

[25] Kiuchi T, Tanaka K, Ito T, Oike F, Ogura Y, Fujimoto Y, Ogawa K. Small-for-size graft in living donor liver transplantation: how far should we go? Liver Transpl, 2003, 9(9): S29-S35

[26] Morioka D, Egawa H, Kasahara M, Ito T, Haga H, Takada Y, Shimada H, Tanaka K. Outcomes of adult-to-adult living donor liver transplantation: a single institution’s experience with 335 consecutive cases. Ann Surg, 2007, 245(2): 315-325

[27] Imura S, Shimada M, Ikegami T, Morine Y, Kanemura H. Strategies for improving the outcomes of small-for-size grafts in adult-to-adult living-donor liver transplantation. J Hepatobiliary Pancreat Surg, 2008, 15(2): 102-110

[28] Miller C, Florman S, Kim-Schluger L, Lento P, De La Garza J, Wu J, Xie B, Zhang W, Bottone E, Zhang D, Schwartz M. Fulminant and fatal gas gangrene of the stomach in a healthy live liver donor. Liver Transpl, 2004, 10(10): 1315-1319

[29] Tanaka K, Yamada T. Living donor liver transplantation in Japan and Kyoto University: what can we learn? J Hepatol, 2005, 42(1): 25-28

[30] Nishizaki T, Ikegami T, Hiroshige S, Hashimoto K, Uchiyama H, Yoshizumi T, Kishikawa K, Shimada M, Sugimachi K. Small graft for living donor liver transplantation. Ann Surg, 2001, 233(4): 575-580

[31] Dahm F, Georgiev P, Clavien P A. Small-for-size syndrome after partial liver transplantation: defi nition, mechanisms of disease and clinical implications. Am J Transplant, 2005, 5(11): 2605-2610

[32] Emond J C, Leib M. The living-related liver transplant evaluation: linking risk factors and outcome. Liver Transpl Surg, 1996, 2(5 Suppl 1): S57-S63

[33] Kiuchi T, Ishiko T, Nakamura T, Egawa H, Uemoto S, Inomata Y, Tanaka K. Duct-to-duct biliary reconstruction in living donor liver transplantation. Transplant Proc, 2001, 33(1-2): 1320-1321

[34] Sugawara Y, Sano K, Kaneko J, Akamatsu N, Kishi Y, Kokudo N, Makuuchi M. Duct-to-duct biliary reconstruction for living donor liver transplantation: Experience of 92 cases. Transplant Proc, 2003, 35(8): 2981-2982

[35] Starzl T E, Groth C G, Brettschneider L, Penn I, Fulginiti V A, Moon J B, Blanchard H, Martin A J Jr, Porter K A. Orthotopic homotransplantation of the human liver. Ann Surg, 1968, 168(3): 392-415

[36] Calne R Y, Williams R. Liver transplantation in man. I. Observations on technique and organization in five cases. BMJ, 1968, 4(5630): 535-540

[37] Tzakis A, Todo S, Starzl T E. Orthotopic liver transplantation with preservation of the inferior vena cava. Ann Surg, 1989, 210(5): 649-652

[38] Polak W G, Nemes B A, Miyamoto S, Peeters P M, de Jong K P, Porte R J, Slooff M J. End-to-side caval anastomosis in adult piggyback liver transplantation. Clin Transplant, 2006, 20(5): 609-616

[39] Dasgupta D, Sharpe J, Prasad K R, Asthana S, Toogood G J, Pollard S G, Lodge J P. Triangular and self-triangulating cavocavostomy for orthotopic liver transplantation without posterior suture lines: a modified surgical technique. Transpl Int, 2006, 19(2): 117-121

[40] Absolon K B, Hagihara P F, Griffen W O Jr, Lillehei R C. Experimental and clinical heterotopic liver homotransplantation. Rev Int Hepatol, 1965, 15(8): 1481-1490

[41] Fortner J G, Beattie E J Jr, Shiu M H, Kawano N, Howland W S. Orthotopic and heterotopic liver homografts in man. Ann Surg, 1970, 172(1): 23-32

[42] Chen X P, Qiu F Z, Xia S S. An experimental study of auxiliary partial liver allotransplantation in dogs. Tongji Yike Daxue Xuebao, 1987, 1(1): 15-20 (in Chinese)

[43] Gubernatis G, Pichlmayr R, Kemnitz J, Gratz K. Auxiliary partial orthotopic liver transplantation (APOLT) for fulminant hepatic failure: first successful case report. World J Surg, 1991, 15(5): 660-665

[44] Rela M, Muiesan P, Vilca-Melendez H, Dhawan A, Baker A, Mieli-Vergani G, Heaton N D. Auxiliary partial orthotopic liver transplantation for Crigler–Najjar syndrome type I. Ann Surg, 1999, 229(4): 565-569

[45] Onaca N, Sanchez E Q, Melton L B, Netto G J, Glastad K A, Martin P A, Ueno T, Levy M F, Goldstein R M, Klintmalm G B. Cadaveric orthotopic auxiliary split liver transplantation and kidney transplantation: an alternative for type 1 primary hyperoxaluria. Transplantation, 2005, 80(3): 421-424

[46] Morioka D, Kasahara M, Takada Y, Shirouzu Y, Taira K, Sakamoto S, Uryuhara K, Egawa H, Shimada H, Tanaka K. Current role of liver transplantation for the treatment of urea cycle disorders: a review of the worldwide English literature and 13 cases at Kyoto University. Liver Transpl, 2005, 11(11): 1332-1342

[47] Shah S A, Grant D R, Greig P D, McGilvray I D, Adcock L D, Girgrah N, Wong P, Kim R D, Smith R, Lilly L B, Levy G A, Cattral M S. Analysis and outcomes of right lobe hepatectomy in 101 consecutive living donors. Am J Transplant, 2005, 5(11): 2764-2769

[48] Testa G, Malago M, Valentin-Gamazo C, Lindell G, Broelsch C E. Biliary anastomosis in living related liver transplantation using the right liver lobe: Techniques and complications. Liver Transpl, 2000, 6(6): 710-714

[49] Gondolesi G E, Varotti G, Florman S S, Muñoz L, Fishbein T M, Emre S H, Schwartz M E, Miller C. Biliary complications in 96 consecutive right lobe living donor transplant recipients. Transplantation, 2004, 77(12): 1842-1848

[50] Hanto D W, Fishbein T M, Pinson C W, Olthoff K M, Shiffman M L, Punch J D, Goodrich N P. Liver and intestine transplantation: Summary analysis, 1994-2003. Am J Transplant, 2005, 5(4 Pt 2): 916-933

[51] Malagó M, Testa G, Frilling A, Nadalin S, Valentin-Gamazo C, Paul A, Lang H, Treichel U, Cicinnati V, Gerken G, Broelsch C E. Right living donor liver transplantation: An option for adult patients: Single institution experience with 74 patients. Ann Surg, 2003, 238(6): 853-862

[52] Marcos A, Killackey M, Orloff M S, Mieles L, Bozorgzadeh A, Tan H P. Hepatic arterial reconstruction in 95 adult right lobe living donor liver transplants: Evolution of anastomotic technique. Liver Transpl, 2003, 9(6): 570-574

[53] Tan H P, Marcos A. Hepatic arterial anatomy for right liver procurement from living donors. Liver Transpl, 2004, 10(1): 134-135

[54] Renz J F, Kin C J, Saggi B H, Emond J C. Chapter 47: Outcomes of living donor liver transplantation. In: Busuttil R W, Klintmalm G B, eds. Transplantation of the Liver. Philadelphia: Elsevier, 2005:713-724.

[55] Pomposelli J J, Verbesey J, Simpson M A, Lewis W D, Gordon F D, Khettry U, Wald C, Ata S, Morin D, Garrigan K, Jenkins R L, Pomfret E A. Improved survival after live donor adult liver transplantation using right lobe grafts: program experience and lessons learned. Am J Transplant, 2006, 6(3): 589-598

[56] Marcos A, Fisher R A, Ham J M, Shiffman M L, Sanyal A J, Luketic V A, Sterling R K, Fulcher A S, Posner M P. Liver regeneration and function in donor and recipient after right lobe adult to adult living donor liver transplantation. Transplantation, 2000, 69(7): 1375-1379

[57] Kawasaki S, Makuuchi M, Ishizone S, Matsunami H, Terada M, Kawarazaki H. Liver regeneration in recipients and donors after transplantation. Lancet, 1992, 339(8793): 580-581

[58] Nakagami M, Morimoto T, Itoh K, Arima Y, Yamamoto Y, Ikai I, Yamaoka Y. Patterns of restoration of remnant liver volume after graft harvesting in donors for living related liver transplantation. Transplant Proc, 1998, 30(1): 195-199

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