Technical variations in living donor liver transplantation

Purpose of review During the last 10 years, much progress has been made in the technical aspects of living donor liver transplantation (LDLT). In fact, LDLT has contributed to understanding of the detailed anatomy of the liver and performing more precise hepatectomy. This review focuses on donor hepatectomy and hepatic vein reconstruction in LDLT. Recent findings At least eight types of donor hepatectomies have been reported. The hanging maneuver, which was originally designed for a large tumor invading the diaphragm in the right liver, has been applied to live donor hepatectomies. Instead of a blind insertion, the tape is inserted under direct vision in LDLT after mobilization of the liver. Modified techniques of hanging maneuver have been used for the preserving the middle hepatic vein (MHV) tributaries and for left-sided liver resections. Reconstructing the outflow is a crucial part of determining the success of LDLT. Many technical variations of outflow reconstructions have been reported. The necessity of providing venous drainage of the right anterior section of the liver of a right liver graft is still controversial. The graft including MHV is the best design for outflow drainage, but most centers are disinclined to use this graft. It may be a better strategy for reconstructing MHV when necessary for donor safety. Summary In LDLT, donor safety is paramount. Technical innovations should not be associated with any unexpected harm to the donors.