Speciality
Spotlight

   




   

Surgery


   

 





General
Surgery Transplantation

     

  • J.
    Belghiti and F. Durand [ Departments of Digestive
    Surgery and ‘Hepatology, Hospital Beaujon,
    University Paris VII, 92118 Clichy Cedex, France

    Living
    Donor Liver Transplantation : Present and Future

    Br.
    Jour. of  Sur.
    Volume 87, No.11, November 2000, Pgs- 1441-1443

       

    Living
    donor liver transplantation has been an acceptable
    modality of therapy for ten years now. The progress
    in this
    field has
    been seen mainly in Japan. [ Almost 1000 such
    procedures have been done] because of absence of
    cadaveric donors and the technical expertise of south
    east surgeons in hepato biliary surgery.
    As a result
    of this, left hepatectomy for living donation for
    children and small adults has almost become routine.
    The results of living donation proved to be better
    than cadaveric donation in pediatric cases.
    This was attributed to factors other than
    immunological ones because the need for
    immunosuppression and the incidence of rejection were
    almost similar. The
    non immunologic factors contributing to better results
    were likely to be [1]
    good quality of graft [2] very short period of cold
    ischaemia [3] the ability to plan the procedure both
    from the availability of surgical expertise and
    choosing the optimal time for the recipient. The good
    results of this procedure illustrate its superiority
    over the partial graft procedure.

         

    However
    in adults this procedure is problematical.
    Several reports suggest that a liver graft
    representing less than 0.8% of the recipient’s body
    weight has a high risk of failure. 
    As a result an attempt is now being made with
    right side grafts in adults.
    This has raised some concerns [ 1] It carries a
    potential 200% mortality risk [2] Complications such
    as peptic ulcer and pulmonary embolism remain a major
    concern, in addition to the development of coagulation
    disorders. [3] The number of adults awaiting liver
    transplantation is ten times higher than children and
    this poses a major problem of donor availability,
    donor morbidity and mortality.

      

    This
    has led to efforts to set up definite guidelines aimed
    at selection of recipient. Those at high risk are
    therefore kept out or excluded, which can be
    misconstrued; it may not be applicable to those who
    have their own donors available. More centers
    therefore need to be developed to address the
    increasing demand.

           

    Then
    there is the psychological dilemma as, in the absence
    of living donation a patient may be condemned to
    die without a transplant.
    Again relatives who
    have participated in a palliative
    transplantation may face psychological morbidity
    because life expectancy may be very short.

        

    Finally,
    in order to prevent commerce in transplantation,
    living donation has been limited in several European
    countries to first degree relatives with the
    possibility of extension to spouses in emergency
    situations. In
    France, – bioethical law – [informed consent of
    potential living donor has to be given to a judge]
    gives added protection against commerce in
    transplantation.

             



 

   

Speciality Spotlight

   

   
Surgery
   

 

General Surgery Transplantation
     

  • J. Belghiti and F. Durand [ Departments of Digestive Surgery and ‘Hepatology, Hospital Beaujon, University Paris VII, 92118 Clichy Cedex, France
    Living Donor Liver Transplantation : Present and Future
    Br. Jour. of  Sur. Volume 87, No.11, November 2000, Pgs- 1441-1443
       
    Living donor liver transplantation has been an acceptable modality of therapy for ten years now. The progress in this field has been seen mainly in Japan. [ Almost 1000 such procedures have been done] because of absence of cadaveric donors and the technical expertise of south east surgeons in hepato biliary surgery. As a result of this, left hepatectomy for living donation for children and small adults has almost become routine. The results of living donation proved to be better than cadaveric donation in pediatric cases. This was attributed to factors other than immunological ones because the need for immunosuppression and the incidence of rejection were almost similar. The non immunologic factors contributing to better results were likely to be [1] good quality of graft [2] very short period of cold ischaemia [3] the ability to plan the procedure both from the availability of surgical expertise and choosing the optimal time for the recipient. The good results of this procedure illustrate its superiority over the partial graft procedure.
         
    However in adults this procedure is problematical. Several reports suggest that a liver graft representing less than 0.8% of the recipient’s body weight has a high risk of failure.  As a result an attempt is now being made with right side grafts in adults. This has raised some concerns [ 1] It carries a potential 200% mortality risk [2] Complications such as peptic ulcer and pulmonary embolism remain a major concern, in addition to the development of coagulation disorders. [3] The number of adults awaiting liver transplantation is ten times higher than children and this poses a major problem of donor availability, donor morbidity and mortality.
      
    This has led to efforts to set up definite guidelines aimed at selection of recipient. Those at high risk are therefore kept out or excluded, which can be misconstrued; it may not be applicable to those who have their own donors available. More centers therefore need to be developed to address the increasing demand.
           
    Then there is the psychological dilemma as, in the absence of living donation a patient may be condemned to die without a transplant. Again relatives who have participated in a palliative transplantation may face psychological morbidity because life expectancy may be very short.
        
    Finally, in order to prevent commerce in transplantation, living donation has been limited in several European countries to first degree relatives with the possibility of extension to spouses in emergency situations. In France, – bioethical law – [informed consent of potential living donor has to be given to a judge] gives added protection against commerce in transplantation.
             

 

By |2022-07-20T16:43:44+00:00July 20, 2022|Uncategorized|Comments Off on General Surgery Transplantation

About the Author: