Living liver Transplantation

Feature Summary

Living donor liver transplantation is a not a simple operation but needs pre-operative careful evaluations for healthy live donors and sick recipients, delicate donor and recipient operations and complicated post-operative cares. The live donor operation is to harvest 60-70 % of liver (right liver) for an adult recipient or 15-40% liver (left liver) for a child recipient. The donor should be blood relatives or relatives in law.

 

Overview

Indications to living donor liver transplantation:

(1) End stage liver cirrhosis: In adult, the causes include chronic hepatitis, alcoholism, Wilson’s disease and autoimmune disease etc. In children, the main cause is biliary atresia.

(2) Metabolic liver disease: when the condition cannot be well controlled by special formula and drugs.

(3) Liver cancers: hepatocellular carcinoma (meet UCSF criteria) and hepatoblastoma resistant to chemotherapy and unrespectable.

(4) Other liver associated diseases which can be treated by replacement of a new liver.

 

Features

The liver transplantation is to replace patient’s native liver with a healthy whole or partial liver (living donor is partial liver). Under regular immune-suppressive medications, the implanted liver will function well and perform the functions of normal liver. This operation is a life-saving procedure.

 

Procedure

Donor and recipient operations are performed simultaneously in two operation rooms. There are two operative and anesthetic teams. The donor’s operation includes laparoscopic dissection of ligamentous attachment of donated part liver, midline incision to dissect portal hilum and dissection of liver parenchyma. The graft is taken out according to the recipient’s operation, which means at the time of diseased liver already removed. The graft is cold flushed and then taken to recipient’s operation room. The recipient’s operation includes a Benz incision, total hepatectomy and then implantation of the donor graft. The usual time for donor and recipient operations is 8 hours and 12 hours respectively.

 

 

 

Notification

  • Donor:
  1. Minor complications: bile leakage: 1-2%, post-operative bleeding needs reoperation: 0.5%, right pleural effusion needs aspiration of pleural fluid: 1-2%, post-operative intestinal ileus: 1-2%. Dyspepsia: 5-10%
  2. Major complications: biliary stricture: 0.5% thrombosis of inflow or outflow of residual liver: 0.5%.
  3. Surgical mortality: 0.1-0.3% for donation to adult patients, 0.1% for donation to children.
  • Recipient:
  1. Minor complications: bile leakage: 5%, post-operative bleeding needs reoperation: 5-10%, pleural effusion needs aspiration of pleural fluid: 10%, post-operative intestinal ileus: 5-10%, biliary anastomosis stricture: 20-30%.
  2. Major complications: thrombosis or stenosis of inflow or outflow of graft liver: 3-5%, sepsis: 3-5%, others: 5%.
  3. Surgical mortality: 3% non-acute liver failure patients, 10-20% for acute liver failure patients.

 

Estimated Cost

  • Donor:1,000,000 NTD
  • Recipient:2,500,000 NTD
  • Prices are subject to change without prior notice, and need to pay in accordance with the actual medical expenses.