A team from the University Hospital of Navarra (CUN) has made a Liver transplant using as a graft the posterior area of ​​the organ of the donor, a new surgical technique that allows to increase between 15 and 20 percent the number of possible liver transplants between alive.

As reported by the CUN in a statement, it is a pioneering surgery in the West, since the conventional intervention that is usually performed in Western hospitals uses the right or left hepatic donor lobe.

"With this procedure, a range of new possibilities for liver transplantation is opened, which, until now, due to the anatomical characteristics of the donor's liver, were not feasible. For this reason we were forced to reject the possibility of performing approximately 15% of liver transplants between the living, "says Dr. Fernando Pardo, director of the Hepatobiliopancreatic Surgery Service of the University Clinic of Navarra.

"Due to the anatomical characteristics of the donor's liver, we were forced to reject the possibility of performing approximately 15% of liver transplants between the living"

The standard surgical technique usually contemplates the extraction of the right hepatic lobe of the donor. "Due to the characteristics of Western patients, it is usually necessary to extract 60% of the donor's liver to obtain a suitable graft for the recipient," says Dr. Fernando Rotellar, specialist of the Hepatobiliopancreatic Surgery Service of the Clinic. Said hepatic proportion - 60% of the organ to be transplanted to the recipient and up to a minimum of 30% to keep in the donor - is the necessary so that there are no problems of liver failure in the postoperative period, both surgeons emphasize.

Sometimes, the anatomical characteristics of the donor's liver impede to maintain the adequate proportion between the volume of the graft necessary to donate to the recipient and the one that must remain in the donor. In these cases, if one of the two lobes is removed - left or right - the donor could have insufficient liver volume for adequate liver function. If this circumstance occurs, the transplant of that donor must be dismissed.

Characteristics of the case

On April 5, the team of surgeons of the Clinic approached a liver transplant inter vivos, in which the aforementioned particularities concurred. "In this particular case, the donor's left lobe contained less than 30 percent of his liver, so it was not feasible to carry out the usual donation, since he would have had less liver volume than necessary," they write.

Following the standard protocol, the graft transplant from the wife-donor to her husband-recipient would have been dismissed. However, the specialists of the Clinic observed the characteristics of the posterior segments of the donor's liver and confirmed the possibility of practicing the intervention successfully. "In this particular transplant, the donor presented a posterior hepatic right sector - segments 6 and 7 with sufficient volume for the recipient's weight. A graft was obtained with both segments, which for the donor involved only 40% of their liver, "says Dr. Pardo.

The evolution of the donor and recipient was excellent, so that they were discharged at 7 and 13 days, respectively, they have added from the CUN.

Source: EUROPE PRESS

Liver Transplant | Cincinnati Children's (November 2019).