From the Guidelines
Yes, individual liver lobes can be transplanted, as evidenced by the most recent and highest quality study 1. This procedure, known as living donor liver transplantation, involves removing a portion of a healthy donor's liver (typically the right lobe for adult recipients or the left lateral segment for pediatric recipients) and transplanting it into the recipient. The remarkable regenerative capacity of the liver allows both the donor's remaining liver and the transplanted portion to grow to normal size within weeks. Some key points to consider in this procedure include:
- Careful matching between donor and recipient, with considerations for blood type compatibility and size requirements, as noted in 1.
- Donors undergo extensive evaluation to ensure they can safely donate, and the surgery carries risks including bleeding, infection, and bile leaks, as discussed in 1.
- Recovery typically takes 2-3 months for donors, while recipients require lifelong immunosuppressive medications such as tacrolimus, mycophenolate mofetil, and corticosteroids to prevent rejection, as mentioned in 1.
- This approach helps address the shortage of deceased donor organs and can provide a life-saving option for patients with end-stage liver disease, as highlighted in 1 and 1. The outcomes of liver transplantation have been very good, and have gradually improved over the last several years, with the chances of surviving one year close to 90% and the 5-year survival rate around 70%, as reported in 1. However, it is essential to consider the potential complications and long-term issues associated with immunosuppression, such as the onset of diabetes, chronic renal failure, hyperlipidaemia, atherosclerosis, or de novo malignancy, as noted in 1. Overall, living donor liver transplantation is a viable option for patients with end-stage liver disease, and the most recent evidence 1 supports its use as a life-saving treatment.
From the Research
Transplanting Individual Lobes of the Liver
- Transplanting individual lobes of the liver is a viable option, as seen in living donor liver transplantation (LDLT) 2, 3, 4.
- The right lobe and left lobe can be used as grafts in LDLT, with the choice depending on the recipient's size and the donor's anatomy 3, 4.
- Studies have shown that right lobe grafts can be used safely and effectively in adult recipients, allowing for the expansion of the indication for LDLT to larger-size recipients 4.
- The use of individual lobes as grafts has also been explored in terms of immunosuppression, with studies showing that tacrolimus dosing requirements may be lower in recipients of partial liver transplants from living donors compared to those receiving whole-liver transplants from cadaveric donors 5.
Donor and Recipient Outcomes
- Donor safety is a top priority in LDLT, and strict donor selection according to structured protocols and center experience are crucial in determining donor safety 6.
- Recipient outcomes have been shown to be similar between right lobe and left lobe LDLT, with some studies suggesting that left lobe LDLT may offer fewer complications for donors 3.
- The incidence of major complications, biliary complications, and vascular complications has been shown to be similar between right lobe and left lobe LDLT recipients 3.
Immunossuppression and Graft Survival
- Immunossuppression regimens have been studied in the context of LDLT, with some studies showing that completely steroid-free triple-drug immunosuppression with tacrolimus, mycophenolate mofetil, and basiliximab is safe and efficient in preventing acute rejection in adult recipients of living donor liver transplants 2.
- Graft survival has been shown to be similar between right lobe and left lobe LDLT recipients, with some studies suggesting that the use of individual lobes as grafts may offer advantages over deceased donor liver transplantation 6.