Gratt Safety Limits in LRLT : Donor and Recipient

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Since the year of 1990 in Shinshu University and Kyoto University, the living-related liver transplantation (LRLT) has been used as a form of treatment for terminal liver disease patients. From this time, our attention has been turned to two problems that repeatedly appeared.One of the problems is how much liver tissue can be taken as a graft without compromising the donor's health status. The other one is about the smaller graft that can support the recipient's metabolic demands.In the last four years period we have performed 32 LRLT with a survival rate of about 90% (28 out of 32 patients) and have worked to solve these two problems. Here we briefly describe some of the conclusions.From the total of 38 donors, 14 were submitted to left lateral segmentectomy ; 13 donors submitted to extended left lateral segmentectomy, and 11 donors submitted to a left lobectomy. All the donors had a postoperative period without major complications, being discharged in an average of one week, and retu … More rning to their social activities within two months. Based on these results it was made clear that the left lobectomy can be carried out for grafting in a normal subject without problems related to parenchyma reduction.With regard to the smaller graft that can fit the demands of the recipient, we successfully transplanted to an adult patient a graft that was as small as 34% of the estimated standard liver volume (based on the body surface area). It represents a donor with good liver function, a graft harvested and transplanted based on safety metabolic limits (established for hepatectomies) , and also confirms the viability due to excellent preservation conditions related to the LRLT.Analyzing the data obtained in these four years, we could conclude that the LRLT can be a safe procedure for healthy donors providing even the whole left lobe and for recipients receiving a graft that represents at least 34% of their standard liver volume, calculated from the body surface area. These limits, broader that the ones formerly in use, permit a new array of safe indications for LRLT. Less