ADULT LIVE DONOR LIVER TRANSPLANT

The number of patients with organ failure who are on the waiting list for an organ transplant continues to rise every year. Currently, there are close to 118,000 patients, of whom 17, 000 are waiting for a new liver. On an average, 22 people will die today waiting for a new organ to become available.

Many new strategies have been developed by the liver transplant physicians to alleviate this shortage of deceased donor livers. Some of these include:

1. use of older donors
2. donors who are positive for hepatitis C  or with previous hepatitis B virus infection
3. split – liver grafts
4. use of adult living donor transplants

The first live donor kidney transplant was performed in 1954 in Boston between a set of identical twins. The first live donor liver transplant using the left lobe was performed in 1989 between an adult to a child. This procedure was adopted to address a severe shortage of donors for children in need of a liver. However, using the left lobe for an adult recipient proved to be unacceptable because a larger volume of donated liver was required to address the higher metabolic needs of an adult. The first successful right lobe donation between two adults took place in 1994.

The advantages of a live donor liver transplant are many. These include:

1. shortened waiting period
2. increase in the number of donors in the overall organ pool
3. decreased time that the graft needs to be on ice, known as cold ischemic time, which leads to better overall function for the recipient
4. more time to optimize the recipient’s medical condition to ensure the best possible outcome after the procedure

Potential disadvantages are:

1. complications of this major procedure in the donor, seen in approximately 15 to 20 % of the donors
2. potential for mortality during or after the procedure

Liver regeneration occurs very quickly after the transplant. By eight weeks, studies have shown that the donor’s liver has grown by 99 % and the recipient’s liver has grown by 140 %.