Smoothing the path: Reducing biliary complications, addressing small-for-size syndrome, and making other adaptations to decrease the risk for living donor liver transplant recipients


  • Arvinder S. Soin

    Corresponding author
    1. Medanta Institute of Liver Surgery and Transplantation, Medicity, Gurgaon, India
    • Liver Transplant Unit, Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, Room 2222, New Delhi, India 110060
    Search for more papers by this author

  • Potential conflict of interest: Nothing to report.


Key Points

1. Over the course of the past 2 decades, living donor liver transplantation (LDLT) has become increasingly successful because many of the technical issues plaguing it have been resolved.

2. Although donor safety remains a concern, most challenges related to the recipient's surgery are now better understood, and they appear surmountable.

3. The following concepts need to be addressed for optimal recipient outcomes to be achieved:

a. Reduction of the risk of small-for-size syndrome in LDLT (ie, the management of 4 factors: the recipient status, the portal pressure and inflow, the venous outflow, and the graft-to-recipient weight ratio/graft quality).

b. Reduction of the risk of surgical complications (biliary complications, reconstitution of the middle hepatic vein outflow in the right lobe graft, and safe hepatic artery and portal vein reconstruction).

c. Other adaptations for improving recipient outcomes (adaptations related to LDLT and adaptations common to deceased donor liver transplantation and LDLT). Liver Transpl, 2012. © 2012 AASLD.