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Abstract Liver transplantation (LT) is a demanding and stressful practice. It requires full dedication and great personal sacrifice. It carries with it a long, difficult learning curve. We present the current situation with one LT team and carried out a critical analysis on the current problems in LT units with regard to access to leadership the future generational changes. An LT team has several similarities with a family-owned company. A generation change planning in liver transplantation may address 3 important aspects: the succession of the leader; establishment and reinforcement of the talent pool; and accessibility to the working group. An LT team is manned by highly qualified personnel. The ideal scenario is when the successor surgeon is accepted by every member in a joint agreement; all the surgeons on the team have the potential to be the next team leader; and the working group presents a high level of personal effort and a motivated attitude. There is an ongoing problem in LT units, however—the growing lack of interest from young surgeons to be part of a transplant team. There are many reasons for this, but it primarily involves the high level of dedication required. The formation of a good transplant team, with a pool of high-quality young surgeons and the realization of a proper generational change, could improve its operation and its results in the future. [ABSTRACT FROM AUTHOR]

Abstract: The continuing shortage of donors has led to the increasing use of marginal grafts. Surgical techniques such as split, domino, and living donations have not been able to decrease waiting list mortality. Donation after cardiac death (DCD) was the only source of grafts prior to the establishment of brain death criteria in 1968. Thereafter, donation after brain death emerged as the leading source of grafts. The context in which irreversible cessation of circulatory and respiratory functions happens was the cornerstone to definite the four categories of DCD by the First International Workshop on DCD held in Maastricht in 1995. Controlled (CDCD) and uncontrolled (UDCD) categories now account for 10%–20% of the donor pool in several countries. Despite initial high rates of primary nonfunction and ischemic-type biliary lesions, refinements in protocols and surgical techniques have led to excellent 1- and 3-year graft survivals of 80% and 70%, respectively with PNF and ITBL rates below 3%. The institution of UDCD and CDCD depends on legal considerations of presumed consent and withdrawal of maneuvers, respectively. The potential for DCD programs is huge; it may be the only real, effective way to increase the grafts pool, both in adult and pediatric populations. Recent advances in perfusion machines will surely optimize this donor pool and allow new therapies for graft resuscitation. [Copyright &y& Elsevier]

Abstract Herein we report on laparoscopic donor hepatectomy (left lateral sectionectomy) for pediatric living donor liver transplantation by using a pure laparoscopic approach. Seven laparoscopic living donor procedures were performed during the period March 2016 to February 2017 at our institution. The average age of donors was 33.3 years. Preoperative liver function was normal in all donors. Four donors required 1 or more Pringle maneuver(s). The etiology was biliary atresia (n = 3), metabolic disorders (n = 2) (OTC deficiency), Alagille syndrome (n = 1), and neonatal ductopenia (n = 1). The graft was implanted orthotopically in 6 patients; we performed an auxilliary transplantation in a patient with an OTC deficiency. The time of donor surgery was 363 minutes. Dindo-Clavien complications among donors were type I (n = 1), type IIa (n = 1), and type IIb (n = 2). The mean hospital stay for the recipients was 14 days. The mean donor stay was 3.7 days. Perioperative donor and recipient mortality was 0%. Graft survival was 87.5% with 1 graft loss secondary to inadequate venous outflow. In conclusion, we can propose the laparoscopic approach in experienced centers as a "standard of practice" due to its minimal complication rate and short hospital stay. [ABSTRACT FROM AUTHOR]