Humans ; Liver Transplantation ; methods ; Transplantation, Autologous ; methods

Living donor liver transplantation (LDLT) was first successfully performed on a child in 1990 and the Shinshu group performed the same procedure on an adult for the first time in 1994. Over the past few years adult LDLT has been increasing worldwide because of the severe shortage of cadaveric organs, especially in locations where the transplantation of organs from brain-dead donors is rarely practiced. The surgical procedures for LDLT are more technically challenging than those for cadaveric whole liver transplantation. LDLT requires a full understanding of hepatobiliary anatomy and continuous technical refinement of the procedure. The development of innovative techniques is a key factor for a successful LDLT. Some of the technical highlights include selective vascular occlusion techniques for donor hepatectomy, hepatic arterial reconstruction under the microscope, the introduction of intraoperative ultrasound, graft volume estimation, hepatic venous reconstruction using cryopreserved vascular grafts, and the use of the right lateral sector of the liver. These techniques have improved the success rate of LDLT over the past few years. This review focuses on the surgical techniques for LDLT on the basis of our experience with adult LDLT at the Tokyo University Hospital.
Humans ; Liver Transplantation/*methods ; *Living Donors

Humans ; Liver Transplantation ; methods ; Tissue Donors

Carcinoma, Hepatocellular ; surgery ; Humans ; Liver Neoplasms ; surgery ; Liver Transplantation ; methods

Liver transplantation is the only way to treat end-stage liver disease. In order to overcome the shortage of donor, marginal donors have been used widely, which bring about a series of problems. Machine perfusion can stimulate the circulation in vivo and is beneficial for the protection of liver. It could also improve the graft function and reduce postoperative complications, which makes it a hot spot in recent years. The aim of this study is to summarize the current status and prospects of application of machine perfusion on clinical liver transplantation.
Humans ; Liver ; Liver Transplantation ; Perfusion ; instrumentation ; methods ; Tissue Donors

China ; Hepatectomy ; methods ; Humans ; Liver Transplantation ; methods ; Living Donors

Human hepatocyte transplantation to treat liver-based metabolic deficiencies and acute liver failure has shown promising early improvement in liver function; however, long-term success has not been achieved. Stem cell transplantation to restore liver function as an alternative to whole liver transplantation has not been successful in humans. As alternative sources of cells for human hepatocyte transplantation, stem cells are under investigation. The liver extracellular matrix presents an ideal scaffold for stem cell differentiation into hepatocytes, as well as cell transplantation. The innovative technique of the decellularized liver matrix presents great potential as the scaffold for hepatocyte maturation and transplantation, and allows the development of engineered recellularized liver graft for transplantation.
Extracellular Matrix ; Hepatocytes ; transplantation ; Humans ; Liver Failure ; surgery ; Liver Regeneration ; Liver Transplantation ; methods ; Stem Cell Transplantation ; methods ; Tissue Engineering ; methods ; Tissue Scaffolds

OBJECTIVETo report the first case of non-composite combined liver and intestinal allotransplantation in China. The technical aspects of the case and pros and cons of such an approach versus composite technique were discussed.

METHODSThe patient suffered from short bowel syndrome and TPN-related liver damage. A non-composite technique was used in this case. During operation, the whole 380 cm intestine was transplanted with systemic drainage and aortic inflow, while the liver graft was placed in a piggyback fashion. Warm ischemic time of donor graft was 2 min and 30 seconds, and cold ischemic duration for intestinal and liver graft was 6 hours and 40 and 8 hours and 7 utes respectively. Postoperative immunosuppression management includes tacrolimus, methylprednisolone, MMF and Zenapax.

RESULTSThe recipient recovered smoothly with no evidence of rejection on days' follow up. Now he is maintained well on enteral nutrition.

CONCLUSIONNon-composite technique should be considered in adult recipients, especially those with a history of abdominal infections or multiple laparotomies.

Adult ; Humans ; Intestines ; transplantation ; Liver Transplantation ; Male ; Short Bowel Syndrome ; therapy ; Transplantation, Homologous ; methods ; Treatment Outcome

China ; Humans ; Liver Transplantation ; methods ; mortality ; trends ; Survival Rate ; trends

Over the past several decades, liver transplantation has experienced remarkable advances in surgical techniques, including venovenous bypass, piggyback method without venovenous bypass, piggyback method with cavaplasty, living-related liver transplantation, splitting liver transplantation, cluster organ transplantation, and liver retransplantation. Based on his experience on 582 case of liver transplantation, the author reviews these techniques and discusses their advantages and disadvantages.
Humans ; Liver Transplantation ; methods ; trends ; Living Donors ; Reoperation