Pediatric Living Donor Liver Transplantation

The introduction of living donor liver transplantation (LDLT) contributed to significantly expand the pool of organs available for children—otherwise disadvantaged by the lack of size-matched donors—resulting in a reduction of mortality on the pediatric liver transplantation (LT) waiting lists. Living donation became an important component of pediatric LT programs worldwide, not only in countries where the shortage of deceased donors leaves no alternative but LDLT, but also in those where split-liver transplantation from deceased donors is largely used. LDLT makes it possible to optimize the timing of transplantation for small recipients as well as to plan the best surgical strategy, resulting in maximizing recipient outcomes and lowering risks in well-selected donors. LDLT has achieved excellent outcomes with an overall survival rate of 90% at 5 years and 75% at 20 years. Satisfactory results have been reported in recent years also for LDLT performed in higher risk categories, such as very small infants transplanted with monosegmental grafts and ABO incompatibility transplantation, due to refinements in surgical technique and donor/recipient matching. Nowadays, the donor surgical procedure for pediatric LDLT is a standardized technique in specialized centers and the laparoscopic approach is widely adopted. For pediatric LDLT, the most common donor procedure is left lateral sectionectomy, which is associated with low mortality (0.1%) and morbidity (10–20%) rates. Hence, a thorough evaluation of the LT candidate and of the potential donor as well as meticulous preoperative surgical planning are essential to detect potential increased risk factors for recipients as well as for the otherwise healthy donor.