Left lateral segment transplantation

The surgical line for right-lobe harvesting in living-donor liver transplantation runs 1 cm right of the middle hepatic vein and parallel to Cantlie s line, and corresponds to a relatively avascular plane (Deshpande et al. 2002 Erbay et al. 2003). For left lateral segment transplantation, the transection is performed along the main lobar fissure. 

LDLT With regard to living donor liver transplantation, SLT has become particularly important in cases where no cadaver organ is readily available. Living donor liver transplantation was first carried out on children. The left lateral segment, usually segments II and III, of the donor s liver is used. Around 5% of OLT candidates are also suitable for LDLT. More than 2,500 living donor liver transplantations have been carried out worldwide. The donor mortality rate is 0.2-0.3%. (115, 116, 122)... 

In 1991 auxiliary partial orthotopic liver transplantation (APOLT) was successfully carried out for the first time in acute liver failure, with the subsequent possibility of dispensing with the transplant after regeneration of the patient s own liver. (112) The corresponding part of a donor liver is transplanted orthotopically as left lateral segments II and HI into the acutely diseased liver. The requisite partial resection of the liver is considered difficult. (121) A European multicentre study (12 centres) achieved equally good results in 30 patients compared to orthotopic liver transplantation with the removal of the native liver (M.-P. Chenard-Neu et al., 1996). APOLT is intended as a temporary measure in acute liver failure with the aim of discontinuing immunosuppressive therapy after the patient s own liver has regenerated. So far, results imply that more complications are experienced in APOLT than in OLT. 

Bile leak with resultant biloma and intra-abdominal infection with abscess formation can occur following reduced-sized, split and living related liver transplantation due to leak from the parenchymal cut-surface or inadvertent bile duct injury. Biliary reconstruction is by Roux-en-Y hepaticojejunostomy, and may involve two anastomoses at implantation of the left lateral segment at split or living related liver transplantation if segment II and III ducts are sepa-... 

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