Initial experience with urgent adult-to-adult living donor liver transplantation in fulminant hepatic failure

Nir Lubezky, Richard Nakache, Michal Carmiel, Ran Oren, Patrick Sorkine, Joseph Klausner, Menahem Ben-Haim*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: The prognosis of patients with fulminant hepatic failure without timely liver transplantation is dismal. Given the limited availability of cadaveric organs for urgent transplantation in Israel, adult-to-adult living donor segmental liver transplantation may be the only alternative. Objectives: To report our initial experience with urgent lifesaving LDLT in this unique scenario. Methods: Three adult patients with FHF (two of unknown etiology, one with paracetamol intoxication) were transferred from other institutions and admitted to our intensive care unit. Initial treatment and monitoring included intracranial pressure monitoring and hepatic dialysis using the Molecular Adsorbent Recirculating System. Expeditious potential donor selection included medical, psychosocial, and surgical evaluation. Liver volume and vascular anatomic compatibility were assessed with computed tomography angiography. Results: Between July and October 2003 we performed three procedures of urgent adult-to-adult LDLT. The donors (two uncles, one sister) underwent hepatic resection (two right lobes, one left lateral segment) and recovered well. The recipients underwent total hepatectomy with caval preservation, followed by lobar grafting. All recipients recovered and are alive with good liver function and without any neurologic complications. Conclusions: Urgent adult-to-adult living donor segmental liver transplantation can be performed safely and timely as a lifesaving procedure in the setting of comatose patients with FHF.

Original languageEnglish
Pages (from-to)467-470
Number of pages4
JournalIsrael Medical Association Journal
Issue number8
StatePublished - Aug 2004
Externally publishedYes


  • Fulminant hepatic failure
  • Living donor liver transplantation
  • Molecular adsorbent recirculating system


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