| 抄録 |
Soon after deceased donor liver transplantation (DDLT) became a standard treatment for patients with end-stage liver disease (ESLD), the supply of deceased donor liver graft was outstripped. In order to overcome the rarity of cadaveric liver graft, split-liver transplantation for two adult recipients using one liver graft and donors after cardiac death have been actively applied in specific centers. However, the widening gap between the growing number of liver transplant candidates and the supply of cadaveric liver grafts becomes a strong motivation for the development of living donor liver transplantation (LDLT). The greatest impact of LDLT has been in Asian countries, where cadaveric organ donation has been uncommon and the prevalence of HBV-cirrhosis and Hepatocellular carcinoma is high. Despite of the challenging nature of the technique of LDLT, there has been continuous innovations. With a better understanding of the physiologic difference of the partial hepatic grafts to avoid graft congestion, small-for-size syndrome, or graft hypoperfusion from portal flow steal, LDLT for the seriously-ill patients with high MELD score can achieve the comparable results with DDLT. Meanwhile, in LDLT, donor safety is of paramount importance, and cannot be compromised regardless of the implication for the intended recipient. At present, efforts has been made to promote the deceased donor organ donation to avoid the live donor’s morbidity and potential mortality. Nevertheless, LDLT continues its role of the most effective alternative to DDLT in the future. |
