pISSN 2671-8790
eISSN 2671-8804

View

Article View

Korean J Transplant 2022; 36(3): 165-172

Published online September 30, 2022

https://doi.org/10.4285/kjt.22.0023

© The Korean Society for Transplantation

Anatomical limits in living donor liver transplantation

Kin Pan Au , Kenneth Siu Ho Chok

Department of Surgery, The University of Hong Kong, Hong Kong

Correspondence to: Kenneth Siu Ho Chok
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong
Tel: +852-2255-3025
Fax: +852-2817-5475
E-mail: kennethchok@gmail.com

Received: May 4, 2022; Revised: June 22, 2022; Accepted: June 22, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We review the anatomical limits of living donor liver transplantation. Graft size is the fundamental challenge in partial liver transplantation. Insufficient graft size leads to small-for-size syndrome, graft failure, and graft loss. However, smaller grafts can be used safely with surgical techniques to optimize outflow and modulate inflow, thereby minimizing portal hyperperfusion. Meanwhile, anatomical variations are common in the vascular and biliary systems. These variants pose additional challenges for vascular and biliary reconstruction. Recognition and appropriate management of these variants ensure donor safety and reduce recipient morbidity. The ultimate principle of partial liver transplantation is to ensure a sufficient graft volume with unimpeded outflow and reconstructable vascular and biliary systems. On this basis, the anatomical limits of living donor liver transplantation can be safely expanded.

Keywords: Living donor liver transplantation, Small for size syndrome, Inflow modulation, Biliary reconstruction, Liver transplantation

HIGHLIGHTS
  • Graft size is the fundamental challenge to partial liver transplantation.

  • Smaller grafts can be used safely with surgical techniques to optimize outflow and modulate inflow.

  • Recognition and appropriate management of anatomical variations in the vascular and biliary systems ensure donor safety and reduce recipient morbidity.