Living-donor liver transplantation

3 The procedure

3.1 Living‑donor liver transplantation requires 2 operations: a partial hepatectomy performed on the donor; and a hepatectomy (of the native organ) with orthotopic liver transplantation for the recipient.

3.2 During the donor operation a liver lobe (right or left) or segment is resected, preserving the main vessels of the systemic and portal circulation and the main branches of the biliary tree. Some surgeons choose to resect the middle hepatic vein with the right lobe. The liver lobe or segment is then transported for transplantation into the recipient.

3.3 Operation on the recipient begins with a hepatectomy. The donor's liver lobe or segment is put in place and the blood vessels and bile ducts are anastomosed.

3.4 The size of graft (that is, right or left hepatic lobe, or liver segment) is determined by the body size ratio or by estimating the standard liver volume of both the donor and recipient. Usually right lobe transplants are suitable for adult recipients, whereas left lobe transplants are used for children, or for adult recipients with a small body size. Liver segment transplants may be used for infants and young children.

3.5 The right lobe is generally considered to be a better graft for recipients because it provides a larger volume of liver parenchyma, and because the blood and biliary vessels are larger and therefore easier to anastomose. However, a right hepatectomy is a more complex procedure and may be associated with an increased risk to the donor.