Living Donor Liver Transplantation

What is Living Donor Liver Transplantation?

Living donor liver transplantation (LDLT) is a procedure that involves a living donor giving a portion of his or her liver to a family member or close friend in need of a liver transplant.

Since the 1990s, Living donor liver transplantation is an accepted curative treatment modality for hepatocellular carcinoma (HCC), which is the most common type of liver cancer.

 

Benefits of an Living Donor Liver Transplantation

The current waiting period for a cadaveric donor liver is often too long to benefit patients with these rapidly progressive diseases. Without living donor liver transplantation, it is highly unlikely that these patients will be transplanted before they develop fatal complications.

Besides being an alternative source of donor livers, the other advantage of living donor liver transplantation over cadaveric liver transplantation is that it allows scheduling of the procedure. As such, the patient with decompensated liver function can be optimised prior to the transplant surgery. In addition, the quality of the liver graft is better as it is retrieved from a healthy donor and the cold ischemic time (the time the donated liver has no blood supply) is much shorter.

The biggest disadvantage of living donor liver transplantation is the potential for complications or even death of a healthy donor. There are limitations with living donor liver transplantation, the foremost is finding a suitable compatible donor, who has the same blood group and is fit to undergo the surgery. The donor can be the next of kin, a relative or even a close friend.

Living donor liver transplantation has several advantages over cadaver donor transplantation, including:

  • Sooner or better recuperation
  • An opportunity for surgery in a more timely fashion i.e. Surgery can be planned for a time when both recipient and donor are in the best condition for surgery. The patient’s condition prior to surgery dictates the recovery time
  • Less possibility for complications and death while waiting for a cadaver donor organ a better opportunity for patients from other countries to undergo transplantation
  • The liver from a living donor may be of better quality because it is harvested from a healthy person. The potential donor has to undergo extensive testing to rule out medical illness and abnormalities.
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    Living Donor Liver Transplantation at AALC

    At AALC, living donor liver transplantation for adults and children is performed by an experienced team of specialist doctors. For patients who have suitable donors, extremely stringent investigations for the donor and recipient are carried out to ensure the safety of both the donor and the optimal graft for the recipient.

    AALC’s highly successful living donor liver transplantation programme is complimented by Parkway Asian Transplant Unit (PATU) – a dedicated Ward with Intensive Care Unit (ICU) facilities, with state-of-the-art medical equipment such as liver dialysis machines and monitoring devices. This ensures that every patient receives the best treatment for his or her specific liver condition.
     

    AALC’s Living Donor Liver Transplantation Outcomes

    Due to the scarcity of deceased donors in Asia, living donor liver transplantation has become feasible option for patients requiring liver transplantation. Led by Dato’ Dr Tan Kai Chah, pioneer of LDLT surgery in Singapore, AALC is one of the top-tier institutions in this field. Since performing its 1st LDLT in 2002, AALC has successfully performed more than 240 living donor liver transplantation to-date with consistently good clinical outcomes.
     

    AALC’s Living Donor Liver Transplantation Survival Outcomes

    Survival outcomes for living donor liver transplantation in patients between 2008-2012, 1-year, 3-year and 5-year survival were 88%, 75% and 69% respectively. Patients transplanted for acute liver failure and malignancy were included in this analysis.

    Living Donor Liver Transplantation
     

    Outcomes for Hepatocellular Carcinoma Recipients

    At least 98 living donor liver transplantation were performed for patients with HCC. Survival outcomes were compared for patients transplanted for HCC *within Milan Criteria and **beyond Milan criteria, a set of criteria used to assess a liver cancer patient’s suitability for liver transplantation. AALC performs living donor liver transplantation to selected patients beyond Milan criteria to provide these patients a chance for cure.

    For overall HCC patients 1-year, 3-year and 5-year survival were 86%, 72% and 64%, respectively. For Milan criteria patients the outcomes were 89%, 82% and 82%, respectively.


    In transplantation medicine, the Milan criteria are applied as a basis for selecting patients with cirrhosis and hepatocellular carcinoma for liver transplantation.

    *Milan criteria – 1 tumour < 5cm or up to 3 tumours < 3cm (NEJM 1996;334)
    **Beyond Milan criteria for AALC are:

  • NO extra hepatic disease
  • NO limitation number or size.

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    Living Donor Liver Transplantation
     

     

    Learn more about the Liver Treatment from Gleneagles Hospital, Singapore Page.