A living donor liver transplant (LDLT) is a surgical procedure in which a patient with a diseased liver receives up to half of a living donor’s liver. LDLT may be a treatment option for patients with a history of acute hepatic (liver) failure, or have a disease process that has resulted in irreversible liver damage such as cirrhosis or hepatocellular carcinoma (liver cancer). Cadaver organs are not always readily available and an LDLT is another potential option for liver transplant patients.
A liver transplant recipient must complete a strenuous screening process, undergo lab tests, diagnostic imaging, and a psychiatric evaluation before they are considered eligible. The recipient must not be smoking or using alcohol, and may be required to attend a treatment program or complete drug screenings periodically to confirm substance cessation. Obesity, pregnancy and a history of mental illness may also result in exclusion from a transplant. The patient’s age, potential life expectancy, and the extent of liver damage involved are carefully considered prior to LDLT. While a patient is considering a LDLT, the recipient’s name will not be removed from the UNOS (United Network for Organ Sharing) list, and will remain on the list for one year post transplant as a precaution should the patient require a transplant if the LDLT is not successful.
Donors do not need to be a relative of the patient, but must have the same blood type, and be willing to take antirejection medications such as Tacrolimus or cyclosporine prior to the procedure. It is important that the donor is honest with medical staff, responding to sensitive historical questions regarding medical history, and reports any signs of illness such as a fever, and must not receive any financial incentive for donating.
The procedure itself is performed at time that works best for both donor and recipient. The procedure will require a team of surgeons, anesthesiologists, and nurses, and takes approximately six to 12 hours for completion. The healthy donor will have up to 50 percent of the right lobe of the liver removed via a large abdominal incision while the recipient will have the entire liver removed in order to receive the healthy organ in the same anatomical position. The surgeons will spend a great deal of time connecting the organ’s vasculature (blood vessels) and close the incision.
Both the patient and the donor will spend several days in the ICU for monitoring, with the donor ideally being discharged 5-7 days post surgery, and the recipient in 10-14 days. Risks for both include bleeding, clotting, and infection and pain, which could prolong the stay for either party. There is less risk in a liver transplant than any other organ transplant, but the recipient will also need to be compliant with daily antirejection medications such as cyclosporine as well as follow up visits as per the transplant center.