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| Insights in living-donor liver transplantation associated with two-stage total hepatectomy: First case in neuroendocrine tumor metastases and functional assessment techniques |
| Laurent Coubeau a , b , ∗, Samuele Iesari a , b , c , Paulina Henry d , Philippe D’Abadie e , Aude Vanbuggenhout a , Raymond Reding a , b |
a Service de Chirurgie et Transplantation Abdominale, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
b Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
c Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
d Service d’anatomo-pathologie, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
e Service de médecine nucléaire, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
∗ Corresponding author.
E-mail address: laurent.coubeau@uclouvain.be (L. Coubeau). |
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Abstract While organ shortage commonly dooms patients on waiting list, alternative options as living-donor liver transplantation (LDLT) are assiduously sought. The principles of liver surgery rule LDLT: there must be sufficient residual volume in the donor and sufficient implanted volume for the recipient. However, the liver left-to-right segmentation confronts us with a respective volume distribution of 1/3–2/3 or even 1/4–3/4. The volume of the left lobe is then too small to ensure the “hepatostat” in the recipient [1], whereas the procurement of a right graft would jeopardize liver residual function in the donor. A Norwegian team combined partial liver transplantation with the procedure associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). This technique was labelled as RAPID (resection and partial liver transplantation with delayed total hepatectomy) and involved deceased-donor left lobes collected by splitting [2]. The first step includes left hepatectomy (segments II, III and IV) and left-graft orthotopic implantation (segments II and III). The native right liver is deportalized by ligation of the right portal pedicle. The ALPPS principles are respected: the reorientation of the complete portal flow towards the graft stimulates regeneration and the physical separation between the remnant and the graft embodies the concept of parenchymal transsection. The rapid volumetric increase of the graft allows right hepatectomy, i.e. the second step, within 15 days. The living-donor RAPID (LD-RAPID), based on left lateral lobe from living donation, has been more recently described [3]. A technical limitation to RAPID seemed to be portal hypertension restricting the technique to non-parenchymal liver diseases, but it has been shown that with good modulation of the portal flow the RAPID technique is applicable to the cirrhotic patient compensated with portal hypertension for hepatocellular carcinoma [4].
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2022, Vol. 21 
