Living Donor Liver Transplantation Techniques

Living donor liver transplantation (LDLT) has evolved into a life-saving procedure that relies on the careful selection of donor grafts, precise surgical planning and enhanced perioperative management. Donor safety remains paramount, guiding the choice between left lateral, left lobe and right lobe grafts according to recipient body size and underlying pathology. Preoperative imaging, notably computed tomography (CT) volumetry, establishes graft size and vascular anatomy, ensuring an optimal graft-to-recipient weight ratio and reducing the risk of small-for-size graft syndrome. Surgical refinements such as minimally invasive donor hepatectomy and refined parenchymal transection techniques have reduced postoperative morbidity. In the recipient, portal flow modulation strategies—including splenectomy, splenic artery ligation and portocaval shunting—are employed to prevent excessive portal hyperperfusion and shear injury to a marginal graft. Advances in machine learning and deep-learning algorithms now support donor–recipient matching and accurate graft weight estimation, further personalising care and improving long-term graft survival. Attention to graft regeneration kinetics, monitored through serial volumetry and liver function markers, underpins protocols for immunosuppression and rehabilitation. Collectively, these technical advances underscore a global trend towards precision LDLT, balancing donor risk and recipient benefit with ever greater fidelity.

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Living Donor Liver Transplantation Techniques publication trend

The graph below shows the total number of articles in living donor liver transplantation techniques across all publications each year (not limited to Nature Index journals).

Technical terms

Graft-to-recipient weight ratio (GRWR): The proportion of graft mass to recipient body weight, critical for avoiding small-for-size graft syndrome.

CT volumetry: Imaging technique that quantifies liver segment volumes to plan graft procurement and ensure adequate remnant liver in the donor and sufficient graft size for the recipient.

Small-for-size graft syndrome: Post-transplant dysfunction characterised by coagulopathy, cholestasis and ascites, resulting from excessive portal flow into an undersized graft.

Portal flow modulation: Intraoperative and perioperative interventions (e.g. splenectomy, portocaval shunt) to regulate portal venous pressure and protect graft microcirculation.

Deep-learning algorithm (DLA): A neural network-based tool that automates liver segmentation on imaging to expedite and refine graft volume estimation.

References

1. Maximizing utility of nondirected living liver donor grafts using machine learning. Frontiers in Immunology (2023).
2. Liver regeneration in donors and adult recipients after living donor liver transplantation. Liver Transplantation (2008).
3. Portal flow modulation in living donor liver transplantation: review with a focus on splenectomy. Surgery Today (2019).
4. Accuracy and Efficiency of Right-Lobe Graft Weight Estimation Using Deep-Learning-Assisted CT Volumetry for Living-Donor Liver Transplantation. Diagnostics (2022).