Emergency living donor liver transplantation (LDLT) serves as a critical procedure for patients grappling with acute liver failure, acute-on-chronic liver failure, and decompensated cirrhosis. This review explores the indications, surgical techniques, challenges, and outcomes of emergency LDLT. Despite the inherent logistical and ethical complexities, carefully selected patients undergoing emergency LDLT achieve survival rates comparable to those seen in elective LDLT and deceased donor liver transplantation. Advances in surgical protocols, immunosuppression, and perioperative care continue to improve outcomes, though further research and standardized approaches are necessary to expand access and optimize results.

Background: Emergency living donor liver transplantation (e-LDLT) is crucial for patients experiencing acute liver failure, acute-on-chronic liver failure, or severe, life-threatening cirrhosis. The purpose of this study was to determine the risk factors that affect the death rate of patients who are waiting for e-LDLT by analyzing data on the Korean Network for Organ Sharing (KONOS). Methods: A retrospective examination of KONOS data was performed, encompassing consecutive e-LDLT applications from 2017 to 2021. Exclusions were made for pediatric patients. The data were classified into two distinct groups. Patients who died before getting e-LDLT were classified as Group 1 (n=38), while patients who spontaneously recovered without liver transplantation, non-emergency LDLT, or deceased donor liver transplantation more than 14 days following e-LDLT treatment were classified as Group 2 (n=30). Results: Significantly greater rates of pre-transplant critical care unit stay, pre-transplant ventilator support, or continuous renal replacement treatment were observed in Group 1 compared to Group 2. In comparison to Group 2, Group 1 exhibited notably lower serum albumin levels and higher model for end-stage liver disease (MELD) scores. Significantly, the MELD score increased by more than 10% for 3 days preceding to e-LDLT applications in Group 1 compared to Group 2. The multivariate analysis revealed that the only factor that affected the death of patients waiting for LDLT after e-LDLT applications was pre-transplant ventilator support. Conclusion The present study suggested that patients receiving mechanical ventilator support in the pre-transplant period should be approached cautiously when deciding on e-LDLT.

Background: Deceased donor liver transplantation (DDLT) and living donor liver transplantation (LDLT) are employed to address highly urgent patients, including those with acute liver failure (ALF), acute-on-chronic liver failure (ACLF), or critical cirrhosis. This study compares outcomes between LDLT and DDLT patients with ALF, ACLF, or critical cirrhosis in highly urgent LDLT (HU-LDLT) applications. Methods: This study conducted a retrospective analysis of the Korean Network for Organ Sharing (KONOS) data, which included 391 consecutive HU-LDLT applications from 2017 to 2021. Results: The proportion of DDLT was 15.1% (n=59) within the cohort of HU-LDLT applications. The prevalence of hepatorenal syndrome, duration of pre-transplant intensive care unit (ICU) care, incidence of pre-transplant continuous renal replacement therapy, and median model for end-stage liver disease scores were significantly greater and prolonged in DDLT patients compared to LDLT patients. Statistical analysis revealed no significant differences in postoperative complications or overall survival between the two groups. In the multivariate analysis, only pre-transplant ventilator care emerged as a significant predisposing factor for mortality. Conclusion The present study indicates that LDLT is a viable option, yielding comparable perioperative and long-term outcomes to DDLT for HU patients, which can encourage living liver donation to overcome organ shortages in HU patients.

Background: Tacrolimus is a key immunosuppressant after liver transplantation.Although guideline-recommended trough levels are 4–10 ng/mL, concerns about nephrotoxicity, metabolic complications, and malignancies have led to interest in minimizing tacrolimus use. However, the effects of lower tacrolimus levels on graft rejection and hepatocellular carcinoma (HCC) recurrence remain unclear. Methods: We conducted a single-center, retrospective study of adult patients (≥19 years) who underwent living donor liver transplantation between January 2000 and December 2021. Patients were divided into low tacrolimus (FK) (<6 ng/mL) and high FK (≥6 ng/mL) groups based on tacrolimus levels measured 1–2 years post-transplantation. We analyzed overall survival, biopsy-proven rejection-free survival, and HCC recurrence-free survival in relevant subgroups. Cox proportional hazards regression identified predictors of mortality, rejection, and HCC recurrence. Results: Among 1,117 recipients, 941 were in the low FK group and 176 in the high FK group. Landmark analysis showed significantly better 10-year overall survival in the low FK group (82.8% vs. 68.8%, p=0.016), while rejection-free survival did not differ significantly beyond 2 years (p=0.098), despite early separation favoring the low FK group (p<0.001). Higher tacrolimus levels independently predicted increased mortality (hazard ratio [HR]=1.98, 95% confidence interval [CI] 1.35–2.89; p<0.001) and rejection (HR=2.20, 95% CI 1.48–3.27; p<0.001). Among 614 HCC patients, landmark analysis revealed no significant difference in recurrence-free survival (77.7% vs. 81.2%, p=0.288) or overall survival (77.3% vs. 65.8%, p=0.215), and FK levels were not independently associated with either outcome. Conclusion Maintaining tacrolimus levels below 6 ng/mL was associated with better survival and rejection outcomes without increasing HCC recurrence, suggesting dose minimization may be feasible in selected patients.

Purpose: Treatment options for hepatocellular carcinoma (HCC) vary according to known guidelines among liver resection (LR), liver transplantation (LT), radiofrequency ablation (RFA), and transarterial chemoembolization (TACE). This study aimed to compare the outcomes of initial treatment for patients with resectable HCC within Milan criteria (MC) via nationwide data. Methods: Patients with resectable HCC (Child-Pugh class A; platelet count, ≥100,000/μL) within MC from the Korean Liver Cancer Association databank were analyzed, retrospectively. Outcomes according to initial treatment and subgroups according to tumor size and number were analyzed. Overall survival (OS) rates after initial treatment were compared. Results: A total of 3,241 patients who underwent LR (n = 1,371), LT (n = 12), RFA (n = 679), or TACE (n = 1,179) were included. The 5-year OS rates differed significantly between the groups (P < 0.05), except for LT (LR, 84.9%; LT, 82.5%;RFA, 76.2%; and TACE, 59.9%). For patients with a single tumor of any size, the 5-year OS rates of the LR group were significantly higher than RFA and TACE groups. For patients with multiple tumors, the 5-year OS rates were 78.2%, 100%, 74.3%, and 53.0% for the LR, LT, RFA, and TACE groups, respectively, but without significant difference between LR and RFA (P = 0.86). Conclusion For resectable HCC within MC, the LR had the highest OS rate for a single tumor of any size. LR and RFA showed no significant differences in OS rate for multiple tumors. LR has a much more optimistic outlook for HCC within MC.

Perihilar cholangiocarcinoma, a rare and aggressive tumor, can develop in the bile ducts at the junction of the right and left hepatic ducts. Successful treatment with of surgical excision and/or transplantation has significantly improved the management of the disease, leading to increased survival rates and better quality of life for patients. Nonetheless, challenges persist, including limited therapy options for advanced-stage disease, potential risks, and a shortage of donor organs. For early-stage disease, surgical resection, usually right hepatectomy, is the preferred treatment, while transplantation is indicated for non-resectable cases. Liver transplantation offers prolonged survival for certain individuals; however, it requires lifelong immunosuppression and carries the risk of recurrence. The choice between resection and transplantation depends on various factors, including disease stage, patient health, and the availability of a donor organ. For patients diagnosed with perihilar cholangiocarcinoma, implementing an interdisciplinary approach is crucial for optimizing therapeutic efficacy.

Perihilar cholangiocarcinoma, a rare and aggressive tumor, can develop in the bile ducts at the junction of the right and left hepatic ducts. Successful treatment with of surgical excision and/or transplantation has significantly improved the management of the disease, leading to increased survival rates and better quality of life for patients. Nonetheless, challenges persist, including limited therapy options for advanced-stage disease, potential risks, and a shortage of donor organs. For early-stage disease, surgical resection, usually right hepatectomy, is the preferred treatment, while transplantation is indicated for non-resectable cases. Liver transplantation offers prolonged survival for certain individuals; however, it requires lifelong immunosuppression and carries the risk of recurrence. The choice between resection and transplantation depends on various factors, including disease stage, patient health, and the availability of a donor organ. For patients diagnosed with perihilar cholangiocarcinoma, implementing an interdisciplinary approach is crucial for optimizing therapeutic efficacy.

Perihilar cholangiocarcinoma, a rare and aggressive tumor, can develop in the bile ducts at the junction of the right and left hepatic ducts. Successful treatment with of surgical excision and/or transplantation has significantly improved the management of the disease, leading to increased survival rates and better quality of life for patients. Nonetheless, challenges persist, including limited therapy options for advanced-stage disease, potential risks, and a shortage of donor organs. For early-stage disease, surgical resection, usually right hepatectomy, is the preferred treatment, while transplantation is indicated for non-resectable cases. Liver transplantation offers prolonged survival for certain individuals; however, it requires lifelong immunosuppression and carries the risk of recurrence. The choice between resection and transplantation depends on various factors, including disease stage, patient health, and the availability of a donor organ. For patients diagnosed with perihilar cholangiocarcinoma, implementing an interdisciplinary approach is crucial for optimizing therapeutic efficacy.