Living donor liver transplantation has become an essential surgical option to address the shortage of deceased donor organs. Unlike recipients, donors are healthy individuals who accept substantial surgical risks solely for the benefit of others.Thus, perioperative anesthetic management must emphasize donor safety, minimize morbidity, and optimize recovery. Key priorities include maintaining stable hemodynamics with minimal blood loss, implementing enhanced recovery after surgery protocols, and delivering effective multimodal pain control strategies. This review integrates current evidence and experience from recent publications to highlight the anesthetic principles guiding minimally invasive living liver donor surgery.

Background: In the era of nucleoside analogs (NA), we investigated the safety of using hepatitis B surface antigen (HBsAg)-positive grafts in liver transplantation (LT) using nationwide KOTRY data. Methods: Among 4,265 adult LTs in the KOTRY registry (April 2014–January 2020), 20 (0.5%) used HBsAg(+) grafts. The S(+) group was compared with HBsAg-nega-tive groups, both HBcAb(+) (C[+]) and HBcAb(−) (SC[−]), using 1:1 propensity scorematching. Patient and graft survival were evaluated using Kaplan–Meier analysis.Cox regression was used to identify prognostic factors. Results: No significant differences were observed in patient or graft survival be-tween S(+) and C(+) or SC(−) groups. Key prognostic factors for patient survivalincluded age, HCC, MELD score, ascites, and encephalopathy. For graft survival, HCC, preoperative HCC treatment, MELD score, ascites, and encephalopathy were significant. HBV recurrence occurred in the S(+) group, but did not compromise outcomes. Conclusion In HBV-endemic regions, HBsAg(+) liver grafts can be safely used to expand the donor pool without compromising LT outcomes when combined with appropriate prophylaxis.

Purpose: Accurate identification of the bile duct bifurcation site is crucial in pure laparoscopic donor right hepatectomy (PLDRH) for living donor liver transplantation. This study aimed to develop and evaluate a deep learning model to predict the bile duct bifurcation site for surgical precision. Methods: We retrospectively analyzed 55 PLDRH procedures conducted between August 2021 and April 2022. A deep learning model combining UNet with a MiT-B3 encoder was trained on 150 manually annotated frames. We then incorporated expert-reviewed pseudo-labels from an additional 901 frames to refine the model. Performance was evaluated using 5-fold cross-validation and an independent test set. Results: Clinical evaluation showed a 97% accuracy in 5-fold cross-validation and 93.3% accuracy in the independent test set. From the initial to final model, dice similarity coefficient improved from 0.392 to 0.472, intersection over union from 0.279 to 0.339, and sensitivity from 0.487 to 0.643, while specificity remained consistent at 0.993. Conclusion The proposed artificial intelligence (AI) model demonstrated strong clinical performance in predicting the bile duct bifurcation site during PLDRH. Despite modest quantitative scores, the high clinical accuracy highlights the potential of integrating AI for precise donor hepatectomy.

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.

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.

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.