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Living-Related Liver Transplantation at UCSFBy Philip Rosenthal, MD Although liver transplantation has become a highly successful and routine procedure for children with end-stage liver disease, access to cadaveric donor organs continues to be a major problem for children awaiting transplant. Innovative surgical techniques have been developed to address this serious problem. Reduced size or cutdown and split liver transplants, in which only a portion of a liver is utilized for the transplant, have been successfully incorporated into many transplant programs. Out of these techniques evolved living-related liver transplantation. In this procedure, part of a parent or relative’s liver, usually the left lateral or left lobe, is utilized for transplantation. Living-related liver transplantation has the potential of significantly improving the outcome for children awaiting liver transplantation. At the University of California, San Francisco Medical Center, living-related liver transplantation has been incorporated as an accepted and routine therapeutic option for all potential pediatric liver transplant recipients, and all families are presented with this alternative. From May of 1992 to December of 1995, eighty-one potential pediatric recipients and 164 potential living donors were evaluated at UCSF. Biliary atresia was the most frequent diagnosis requiring transplantation in this group. Other indications included metabolic liver diseases, cholestatic liver disease, hepatitis, and fulminant liver failure. Candidate ages ranged from less than 1 year to adolescence. One hundred sixty-four potential living donors were evaluated. Of the 164 potential donors, 145 (88%) were interested in pursuing living-related liver transplantation. All were parents except for 2 uncles, 5 aunts and 2 grandparents. The living-related liver transplant donor evaluation begins with a thorough history and ABO blood typing. If the donor is found acceptable at this point, additional laboratory work is ordered to be sure the donor is healthy and has no unsuspected liver disease. A chest x-ray, electrocardiogram and pulmonary function tests to assess the heart and lungs are also obtained. If the donor passes these tests, an abdominal CT scan and hepatic angiogram to evaluate the anatomy of the proposed donor organ is performed. This entire evaluation is performed by a physician not involved with the liver transplant program to insure that the best interests of the potential donor are being considered. Seventy-six of the 145 potential donors (52%) were found to be acceptable in our program, and 69 (48%) were excluded. Reasons for exclusion included ABO blood group incompatibility in 16 (11%), medical contra-indications in 30 (21%), and for social reasons in 23 (16%). Medical contra-indications for potential donors included hepatitis, heart disease, hypertension, diabetes, substance abuse and obesity. Of the 81 potential pediatric recipients, 20 received living-related liver transplants (25%), 31 received cadaveric transplants (38%), 3 expired awaiting a donor organ (4%), and 27 (33%) remain listed awaiting a donor organ. Of these 27, five have completed the living-related transplant evaluation. The average length of stay for living-related liver transplant donors is one week, and donor survival is 100%. Living-related liver transplant donor complications have been few and include one case of biliary leak corrected by endoscopy, and one case of chronic gastritis which was responsive to medical therapy. Immunosuppression following liver transplantation is identical in our living-related and cadaveric transplant recipients. The incidence of rejection is comparable in the living-related and cadaveric liver transplant groups. At the University of California, San Francisco Medical Center,
survival following liver transplantation in children is over 92% at one
year post transplant. Living-related liver transplantation is an
effective therapeutic option that should be considered for all children
requiring liver transplantation. Dr. Rosenthal is Professor of Pediatrics and Surgery, University of
California, San Francisco Medical Center and member of the C.L.A.S.S.
Scientific Advisory Committee.
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Children’s Liver Association
for Support Services
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