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Return to Living Donor Liver Transplants With Laparoscopy Overview

More on Living Donor Liver Transplants With Laparoscopy

Living Donor Liver Transplants With Laparoscopy

NewYork-Presbyterian is First Hospital in U.S. to Perform Procedure

New York (Jun 28, 2010)

Illustration of a human liver

In the United States, over 18,000 individuals are waiting for a liver transplant. But just over 6,000 livers from deceased donors become available each year. Living donor liver transplantation is an approach that enables more patients to benefit from transplantation – and earlier in the course of their illnesses, leading to better outcomes.

NewYork-Presbyterian Hospital/Columbia University Medical Center is the only center in the country performing removal of liver tissue from the donor via laparoscopy in certain individuals. Surgeons have used this approach to perform living donor liver transplantation from an adult to a child, and they are working to expand this program to adult-to-adult transplants in the next year.

"Because of the scarcity of donor organs, living donors are an important part of the care we provide," said Benjamin Samstein, M.D. "A living donor offers the possibility of earlier transplantation to those in need."

Living donor liver transplantation is the removal of a portion of a healthy living person's liver for transplantation into a recipient. This technique is possible because of the liver's ability to regenerate. After about six weeks, the partial liver in both the donor and recipient grow and remodel to form complete, functioning organs.

Benjamin Samstein, M.D.
Benjamin Samstein, M.D.

NewYork-Presbyterian Hospital's Center for Liver Disease and Transplantation (CLDT) was one of the first institutions in the world to perform adult living donor surgery, and currently has one of the largest and most successful living donor programs. Today, up to 20 percent of the liver transplants performed through the CLDT are from living donors – far greater than the 2 to 5 percent national average.

During adult-to-adult living donor liver transplantation, about 50 to 60 percent of the donor's liver is removed. A smaller amount – about 15 to 20 percent – is required for an adult-to-child transplant.

Generally, anyone who is on the list for a liver transplant is a candidate for living donor transplantation. However, this approach is best suited for recipients with a MELD score below 25. (The MELD score is used to grade the severity of a patient's liver disease.) In patients with higher MELD scores, the early demands on the liver can overwhelm the donated liver tissue.

As for donors, the ideal candidate is in general good health, has a blood type compatible with the recipient, has a selfless motivation for donating, and is emotionally close with the patient. Recipients of livers from living donors generally fare better than those who receive livers from deceased donors because they are in optimal health at the time of transplant, and the tissue they receive is usually from a young, healthy donor (with an average age of 38).

Sonja Olsen, M.D.
Sonja Olsen, M.D.

"The timing of the surgery is an important component of success," noted Dr. Samstein. By improving access to transplantation, particularly in regions such as New York that have longer waiting lists, living donor liver transplantation may reduce a patient's risk of dying by 20 to 40 percent.

When a donor liver is removed via conventional surgery, the surgeon makes a 20 to 25 centimeter incision from the breastbone to the belly button. With the laparoscopic approach, which takes four to five hours, the surgeon divides the liver tissue using slender instruments inserted via five small incisions in the donor's upper abdomen.

The donated liver tissue is removed via a three-inch incision in the lower abdomen and transplanted into the recipient via conventional surgery (six to eight hours in duration).

Like other forms of minimally invasive surgery, there are multiple benefits for the donor who is able to donate liver tissue via laparoscopy. The smaller incisions reduce the recovery time from 4 to 8 weeks to just 2 to 3 weeks. The donor experiences less pain and fatigue, has a reduced need for pain medication after surgery, and has a lower risk of complications such as hernia.

A speedier recovery reduces the stress on the donor's family as well, especially when the recipient is the donor's child. "The non-donor parent often has to take care of two patients after surgery," explained Dr. Samstein. "And the parent who served as the donor may feel conflicted because he or she wants to recover, but also wants to take care of the child. Laparoscopic surgery reduces the stress on the caregiver, the donor, and the whole family."

Laparoscopic living donor liver transplantation is one of several advances in the field made in recent years. Approaches to screening donors and recipients have improved, leading to better donor selection. "Imaging of the liver has improved so we can better assess the amount of donor tissue needed," added Sonja Olsen, M.D. "Surgeons are also using the left lobe of the liver more often, which is more easily accessible than other lobes."

"If we can continue to increase our use of laparoscopy for living donor liver transplantation, we may be able someday to use this technique for all of our adult-to-adult living donor transplants," concluded Dr. Samstein. "That may enable up to 50 percent of liver transplants to be performed from living donors, which would lead to better outcomes and more access for people suffering from liver disease."

Related Video

Dr. Samstein discusses living donor liver transplants in several videos on NewYork-Presbyterian's YouTube channel.

For More Information

For more information, please call 877-LIVERMD (877-548-3763) or visit http://nyp.org/services/transplantation-surgery/liver-transplant.html

Contributing faculty for this article:

Benjamin Samstein, M.D. is the Surgical Director of the Living Donor Liver Transplant Program at The Center for Liver Disease and Transplantation (CLDT) at NewYork-Presbyterian Hospital/Columbia University Medical Center and an Assistant Professor of Surgery at Columbia University College of Physicians and Surgeons.

Sonja Olsen, M.D. is an Assistant Attending Physician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and an Assistant Professor of Medicine at Weill Cornell Medical College.

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