الفهرس 
ACKNOWLEDGMENTOnly 14 pages are availabe for public view
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Abstract
Background: The living donor procedures are considerably more complex than whole organ decreased donor transplantation and there are unique considerations involved in the assessment of any specific recipient and donor. Donor selection and evaluation have become highly specialized. The critical issue of size matching is determined by both the actual size of the donor graft and the recipient as well as the degree of recipient portal hypertension. The outcomes after LDLT have been at least comparable to those of deceased donor transplantation. Nevertheless, all efforts should be made to improve deceased donor donation so as to minimize the need for living donors. Transplantation physicians, particularly surgeons, must take responsibility for regulating and overseeing these procedures.
Aim of Work: To study and identify donor and recipient characteristics of LDLT, and to determine different variables that affect graft survival, and outcome of the operation and management of surgical complications for both the donors and the recipients.
Methods: This study included 150 cases of living donor liver transplantation which were performed during the period from April 2004 to the end of 2011 at the Gastrointestinal Surgical center. Preoperative evaluation of donor was performed. The donor work up included history taking, clinical examination, detailed laboratory work up comporising chemical, hematological, microbiological studies, imaging studies by CT angiography and cholongiography, volumetry, liver biopsy, psychosocial and anesthetic assessments. Donor consent was obtained at the beginning of evaluation. Intraoperative, donor surgery was synchronical to recipient surgery as to minimize the cold ischemia time. Intraoperative cholangiography was done in every case. Harmonic scalpel was used in parenchymatous transection. Biliary anastomosis was done duct to duct anastomosis except in one case we done hepaticojejonostomy. Venous grafts (synthetic or autologous grafts) were used if veins of segment V, VIII veins were more than 5 mm.
Results: The indications for LDLT in our cases was HCV cirrhosis in 97 cases, HCC in 51 cases, one case immune hepatitis and one case buddchiori. Males donors present 71.33 and females 28.66% with mean age 27.6 ± 2.7. The recipient mean age was 47 ± 23 years, males were more than females (92.6%, 7.3 % respectively). The mean MELD score was 18.4 ± 13. 129 donors were related and 21 unrelated, with mean BMI was 26.9 ± 2.7. The mean graft weight was 999 ± 176 gram. The remaining mean liver volume was 36.8 ± 7.7 of their initial volume. Steatosis was less than 20 %. The donor operative time was with mean 6 hours and the recipient operative time was mean 11 hours .The mean cold ischemia time was 62 ± 29 minutes, and the mean warm ischaemia time was 60 ± 27 minutes. Hepatic venous anastomosis was single in 89 cases, double in 45, triple anastomosis in 12 cases. Single biliary anastomosis was done in 78 cases (52%), double biliary anastomosis in 67 (44.6%) cases, triple anastomosis in 4 (2.66%) cases and hepaticojejunostomy in one case .
Conclusions: LDLT offers hope to patients with end stage liver disease in area where waiting – time mortality is high and the availability of deceased donor organs grafts falls short of population need or not available as in our country.