Live Donor Liver Transplant
Live donor liver transplantation (LDLT) is a procedure in which a living person donates a portion of his or her liver to another. The feasibility of LDLT was first demonstrated in the United States in 1989. The recipient was a child, who received a segment of his mother's liver. Since that time, LDLT for children has enjoyed wide success and many pediatric programs use this technique.
In the pediatric experience, survival of both the recipient and the transplanted liver (graft) at 1 year is about 90%. Donor complications have been very few. A rising population of adult patients awaiting liver transplantation has led to the application of LDLT for adult patients, and the preliminary results have been very encouraging. Only a handful of centers in this country perform the procedure.
The transplant team from USC has been performing LDLT at the Children's Hospital of Los Angeles (CHLA) for some time with excellent results. This USC team also performed the first adult-to-adult LDLT in Southern California, and the world's first adult-to-adult LDLT without blood transfusion. Encouraged by these results, we now offer this option as standard treatment in adults who have suitable donors.
The information presented in a question and answer format is intended to address all the usual questions that arise when considering this option.
Where does the transplant occur?
- All adult liver transplants are performed at the USC University Hospital.
- Pediatric liver transplants are performed in conjunction with Children's Hospital Los Angeles.
When does the transplant occur?
- The transplant is scheduled at a mutually convenient time for the donor and recipient. In the case of the latter, the team members will decide the optimal time based on condition of the recipient and control of complications. For example, if the recipient develops a sudden fever, the procedure will be delayed until the cause is found and potential infection controlled.
- The advantage of LDLT is that the procedure can be timed in such a way as to perform the procedure on both the donor and recipient when both are in the best possible condition.
How is the operation performed?
- After all of the medical issues have been settled and the donor-recipient match-up is completed, a date is selected for the operation.
- Two teams perform the donor and recipient operations simultaneously.
- As the diseased liver is removed from the recipient by one team, approximately half of the donor's normal liver is removed by the other team.
- Once the donor operation is completed, both surgical teams complete the transplant by attaching the half-liver into the recipient.
- The donor operation usually takes about 5 hours and the recipient operation about 10 hours.
- Both half-livers (of donor and recipient) grow to be full sized in 6-8 weeks.
What is the post-operative period like for the donor?
- Prior to the transplant procedure, the donor will receive a detailed description of the procedure and will have an opportunity to discuss the potential risks or side effects of the operation.
- The donor is usually in the intensive care unit for about 24 hours and in the hospital for 5-7 days. Most patients are up and out of bed (with assistance) by the second or third postoperative day. It is usually necessary to stay off work and usual home activities for a month full time and 2 to 4 weeks part time, depending on the rapidity of the recovery.
Donor and Recipient
Basic facts regarding the Recipient:
- Patients being considered for LDLT are those who are candidates to receive a cadaveric liver (liver from non-living, unrelated individual) based on the severity of their liver disease and its complications. These patients are placed on the liver transplant waiting list and will not be denied a donor liver if it becomes available prior to LDLT. Thus, failure to find a suitable donor for LDLT will not jeopardize the recipient's chances of receiving a cadaveric liver
- Patients considered for LDLT will be followed by the same USC liver transplant team who will manage all complications of liver disease with a view to optimizing the patient's condition prior to liver transplant.
Basic facts regarding the donor:
- The donor could either be a relative (close or distant) or even be unrelated.
- The blood type of the donor should be the same as the recipient's.
- The donor should be in good physical and mental health.
- The decision to be a donor should be made after careful consideration of facts and knowledge of the procedures, the risks and complications.
- There should be no evidence of financial gain arising out of the donation.
- The donor must be relatively close in size (or larger) than the recipient.
What constitutes a good donor?
A good donor is someone who is in good physical and mental health, older than the age of 18 and free from:
- HIV infection
- Known viral hepatitis
- Active alcoholism with frequent and heavy alcohol intake
- Psychiatric illness under treatment
- History of malignancy
- Heart and lung disease requiring medications
- Diabetes mellitus of greater than 7 years duration
What is the process for evaluating a donor?
- The potential donor will be asked to complete a questionnaire that includes attaching a copy of his or her blood type (to confirm whether this is compatible with the recipient).
- If the blood type is compatible with that of the recipient and the details on the questionnaire indicate suitability, the donor is evaluated by an internist (liver specialist or hepatologist) who will obtain additional history, perform a physical examination and administer appropriate blood and urine tests.
BLOOD TYPE COMPATIBILITY CHART
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- If the physical examination and tests confirm that the donor is suitable and the donor's size (height/weight compared to that of the recipient) is appropriate, a CT scan will be arranged to calculate the volume of liver that will permit a successful outcome. [Prior to having the CT scan the donor must notify the team of any allergies to iodine or radioiodinated contrast.]
- At this stage, the potential donor will also be interviewed by a social worker from our team. Under some circumstances, a psychiatric evaluation may be appropriate.
- When complete, the medical and social details of the evaluation are discussed at a conference by the transplant team members.A decision regarding the suitability of the donor will be made at that time. This decision will be communicated to the donor by one of the team members (usually the transplant coordinator). If not selected, physician team members can be contacted for explanation. [All information concerning the donor is kept in strict confidence.]
Want to Learn More About Live Donor Liver Transplants?
Live donor liver transplants are performed as a result of an increased number of patients on the liver transplant waiting list and the shortage of available organs. Live donor transplantation is a procedure where a healthy person donates half of his/ her liver to a family member or close friend on the waiting list. The USC liver transplant team specializes in these procedures.
If you or someone you know is interested in learning about live donor liver transplantation, please join us for an educational forum. Potential donors and their families are encouraged to come. Please bring all your questions about live donor liver transplantation! Topics to be discussed will include indications for the procedure, qualifications for the operation, details about the surgery, risks and benefits, and recipient and donor outcomes. You will have a chance to discuss your questions or concerns with other family members.
USC University Hospital
2nd Tuesday of each month, 1:30-2:30 p.m.
For classroom location, please ask the concierge on the 1st floor
For more information, call (323) 442-5908