Chapter 22 - Living donor liver transplantation

Summary

Careful selection of both donor and recipient is crucial in preventing donor complications and optimizing recipient outcomes. Hepatocellular carcinoma (HCC) patients usually have less portal hypertension and lower chemical Model for End-Stage Liver Disease (MELD) scores. Donor selection criteria vary slightly among different programs. Donor safety is the primary concern; therefore, the ideal graft is the one that leaves a donor a future liver remnant (FLR) above 35% and at the same time provides a graft with an adequate size with respect to the recipient. Despite donor safety being of paramount importance in living donor liver transplantation (LDLT), finite morbidity and mortality rates has been reported worldwide. Intraoperative hemodynamic studies are emerging in recent years as a tool to guide implantation technique and in low modulation. The severity of liver disease and recipient status along with severe portal hypertension also affects the risk of small-for-size syndrome (SFSS).