What Is a Living Donor Liver Transplantation?

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Living donor liver transplantation arose because of shortages of deceased donors and that's death on the waiting list. The ability to do living donor transplantation dates back to the early days of kidney transplant, but was initially thought impossible for a liver transplantation. Started in children who needed a small liver.

We recognized that the liver ability to regenerate would allow us to take up to 60% of the donor's liver and use it for the recipient and have it regenerate in both the donor and the recipient. This has led to the success of living donor liver transplantation in both children, where it is standard of care, and in adults where we use it in circumstances where the patient is unlikely to be able to make it through the waiting list, or to improve the quality of life with an earlier transplant.

The liver has two lobes, a left lobe and a right lobe, and if we remove one of those lobes the other one will regenerate up to full size in four to six weeks. This allows us to remove part of the liver and have it regenerate in both the donor and the recipient. We've used the smaller part of the left lobe we call the left lateral segment for babies since the 80s.

However when we tried to do left lobe transplants in adults, it was not enough liver for the recipient who was sick and needed more liver than the donor. We started doing right lobe liver transplants in the late late 90s and this proliferated and has become a successful therapy. Now increasingly, we're trying to use the left lobe whenever possible to decrease the size of the operation for the donor and in some cases do it laparoscopically.

This improves the recovery time and decreases the risk to the donor.