Liver Transplant First Highlights Promise of New Approach
Dec 2, 2013
In September of this year, doctors at NewYork-Presbyterian became the first in the nation to report successfully removing a portion of a liver from a living adult donor using a fully laparoscopic procedure and transplant it into a recipient. The achievement is another step in making living donor transplant easier and less risky for the donor.
Historically, liver donations largely come from deceased recipients and there is a long wait list to receive a new liver, with the sickest patients receiving one first. The problem is that there are not enough organs and many patients die waiting for ones to become available.
In a living donor liver transplant, surgery can be electively scheduled for both the donor and recipient, ideally before the recipient experiences life-threatening complications. The NYP team is a leading member of an NIH consortium that has reported that living donor transplant recipients have significantly improved survival over patients who wait for a deceased donor.
"We are at the forefront of perhaps a new era for living-donor liver transplants," said Benjamin Samstein, M.D., the surgeon who led the team. Since the initial surgery, Dr. Samstein's team has conducted four other laparoscopic hepatectomy procedures from living adult donors to adult and teenage recipients. "This is a small step, but I think a useful one," added Dr. Samstein.
In a fully laparoscopic living donor liver transplant, the donor and recipient are placed in adjacent operating rooms. A surgeon removes a portion of the donor's liver and it is immediately placed in the recipient in the adjoining operating room. The recipient operation is performed using standard open technique.
Because of the unique nature of the liver to regenerate, the donor and recipient are both able to maintain normal bodily functions. In fact, the remaining liver in the donor and the transplanted portion of liver in the recipient will eventually grow to normal size, providing long-term liver function for both the donor and the recipient. The laparoscopic hepatectomy procedures have included a 47-year-old man who donated to his young teenage daughter and a 28-year-old woman who donated to her mother-in-law. The surgeons found that the duration of the donor's recovery time was half of a traditional open transplant surgery. In addition, there were no postoperative donor complications, and patients showed less pain.
Currently only about 4% of liver transplants are performed with a living donor compared with almost 50% of kidney transplants. "Even though there is a tremendous need, we are not seeing the same use of living-donor livers as we are of living-donor kidneys," said Dr. Samstein. With these new advances, doctors hope that living donor liver transplantation will be an attractive option to deceased donor liver transplantation for the many patients who are seeking an organ transplant.