Korean J Transplant.  2022 Sep;36(3):165-172. 10.4285/kjt.22.0023.

Anatomical limits in living donor liver transplantation

  • 1Department of Surgery, The University of Hong Kong, Hong Kong


We review the anatomical limits of living donor liver transplantation. Graft size is the fundamental challenge in partial liver transplantation. Insufficient graft size leads to small-for-size syndrome, graft failure, and graft loss. However, smaller grafts can be used safely with surgical techniques to optimize outflow and modulate inflow, thereby minimizing portal hyperperfusion. Meanwhile, anatomical variations are common in the vascular and biliary systems. These variants pose additional challenges for vascular and biliary reconstruction. Recognition and appropriate management of these variants ensure donor safety and reduce recipient morbidity. The ultimate principle of partial liver transplantation is to ensure a sufficient graft volume with unimpeded outflow and reconstructable vascular and biliary systems. On this basis, the anatomical limits of liv-ing donor liver transplantation can be safely expanded.


Living donor liver transplantation; Small for size syndrome; Inflow modulation; Biliary reconstruction; Liver transplantation


  • Fig. 1 Variants of the hepatic vein. MHV, middle hepatic vein; LHV, left hepatic vein.

  • Fig. 2 Venoplasty between the right hepatic vein (RHV) and middle hepatic vein (MHV) in an extended right lobe liver graft.

  • Fig. 3 Variants of the portal vein and biliary tree. RAPV, right anterior portal vein; LPV, left portal vein; RPSD, right posterior sectoral duct; LHD, left hepatic duct.

  • Fig. 4 Configuration of dual left lobe transplantation and dual left and right lobe liver transplantation.


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