Rajasekar Jasper S, Rammohan Ashwin, Rela Mohamed
The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India.
J Clin Exp Hepatol. 2025 Mar-Apr;15(2):102451. doi: 10.1016/j.jceh.2024.102451. Epub 2024 Nov 15.
Living donor liver transplantation (LDLT) constitutes the majority of liver transplants in Asia and advancements in LDLT techniques have expanded the range of allografts beyond the commonly used right lobe (RL). This review provides a comprehensive overview of lesser-known variants of allografts and LDLT techniques which include right posterior sector grafts (RPSG), dual-lobe liver transplantation (DLLT), auxiliary partial orthotopic liver transplantation (APOLT), and extended left lobe grafts with caudate concentrating on the technical aspects, current evidence, and their indications in contemporary practice of LDLT. The first section examines RPSGs, focussing on their potential as an alternative to RL grafts particularly when volumetric studies indicate a larger right posterior sector in donors. It addresses donor selection, surgical techniques, and potential complications. Next, the article explores DLLT, which optimizes graft volume through partial grafts from two donors. The emphasis is on the ethical considerations, surgical challenges, and haemodynamic risks, such as graft atrophy, highlighting the importance of careful donor selection and meticulous planning. The section on APOLT covers its application in treating acute liver failure (ALF) and metabolic liver diseases. The technique's ability to support liver function in ALF while avoiding long-term immunosuppression when the native liver regenerates is discussed, along with patient selection criteria and follow-up requirements. Finally, the review addresses left lobe grafts with caudate used in smaller adults and older children to increase functional graft volume and improve outcomes.
活体肝移植（LDLT）在亚洲的肝移植中占大多数，并且LDLT技术的进步扩大了同种异体移植物的范围，超出了常用的右叶（RL）。本综述全面概述了鲜为人知的同种异体移植物变体和LDLT技术，包括右后叶移植物（RPSG）、双叶肝移植（DLLT）、辅助部分原位肝移植（APOLT）以及带尾状叶的扩大左叶移植物，重点关注技术方面、当前证据及其在当代LDLT实践中的适应症。第一部分研究RPSG，重点关注其作为RL移植物替代方案的潜力，特别是当体积研究表明供体右后叶较大时。它涉及供体选择、手术技术和潜在并发症。接下来，文章探讨了DLLT，它通过来自两个供体的部分移植物来优化移植物体积。重点是伦理考量、手术挑战和血流动力学风险，如移植物萎缩，强调仔细选择供体和精心规划的重要性。APOLT部分涵盖了其在治疗急性肝衰竭（ALF）和代谢性肝病中的应用。讨论了该技术在支持ALF肝功能同时避免天然肝再生时长期免疫抑制的能力，以及患者选择标准和随访要求。最后，综述讨论了用于较小成人和较大儿童的带尾状叶的左叶移植物，以增加功能性移植物体积并改善预后。
