Living-donor liver transplantation for patients with end-stage liver diseases: 12 cases report

Objective To summarize the clinical experience of living donor liver transplantation (LDLT) of relatives for the end-stage liver disease (ESLD). Methods Clinical data of 12 donors (7 males and 5 females; 19 to 51 years of age; 28 years of mean age) and 12 recipients (7 males and 5 females; 13 to 51 years of age; 39 years of mean age) who underwent LDLT in the First Affiliated Hospital, Xinjiang Medical University from September 2005 to September 2012 were retrospectively analyzed. The real kinship between the donors and recipients was carefully identified and proved. The informed consents of all participating subjects were obtained and all procedures were performed in accordance with the medical ethics. One child received transplantation of left lobe without middle hepatic vein. And the other 11 adults received transplantation of right lobe without middle hepatic vein. Two patients with hepatic alveolar echinococcosis (HAE) were given long-term treatment of albendazole 15-20 mg/(kg·d) . The reconstruction of vessels and bile duct of the grafts, donors and recepients were observed. The anhepatic phase, the blood transfusion volume, operative time, hospital stay and complications were recorded. The donors and recepients were followed up after discharge from the hospital. The complications, survival rate and mortality were observed. Results All operations were successfully performed. The graft weight of the child recipient was 400 g with the graft volume/standard liver volume (GV/SLV) was 0.52. The artery of S4 segment originated from the right hepatic artery. The cystic artery originated from the left hepatic artery. The anastomosis of the S4 segment and gall bladder artery were performed and then the left and right hepatic arteries of the donor and recepients were anastomosed. The graft weight of the other 11 adult cases was 550(450-720) g and the GV/SLV was 0.45 (0.35-0.60). The hepatic veins of S5 segment were bridged and reconstructed with allograft iliac veins. The hepatic veins of S8 segment was anastomosed with the inferior vena cava. For the donors, the intraoperative administration of red cell suspension was 1(0-4) U, the operative time was 318(280-334) min, the postoperative hospital stay was 9(7-12) d; The anhepatic phase of the receptor was 72(45-180) min, the intraoperative administration of red cell suspension was 12(2-35) U, the operative time was 690(580-1 080) min, the postoperative hospital stay was 17(14-28) d. All the donors and recipients recovered well and no complications were observed. The follow-up time of the 12 donors was 3-87 months and all survived. The follow-up time of the 12 recipients was 3-63 months with 8 survivals and 4 deaths. One case died of chronic rejection, one of severe lung infection, one of cerebral hemorrhage and the other one of HCC recurrence. No new intrahepatic and extrahepatic lesions were observed in the 2 patients with HAE. Conclusions Comprehensive and accurate assessment of the donor and recipient’s vessels and bile duct and perfect surgical skills are the keys to the success of living donor liver transplantation. The long-term use of Albendazole after transplantation for HAE patients is the key measure to prevent recurrence of HAE. Key words: Liver transplantation; Living donors; Echinococcosis, Hepatic; Recurrence; Albendazole