Laparoscopic Surgery Could Increase Number of Liver Transplants

Liver transplant surgeons at P&S are the first in the country to report a fully laparoscopic hepatectomy—the removal of a portion of the liver—from a living adult donor for adult and teenage recipients. The procedure offers hope for addressing the shortage of livers available for transplant.

In the September 2013 issue of the American Journal of Transplantation, the team, led by Benjamin Samstein, MD, assistant professor of surgery, reported on two of the center’s five successful fully laparoscopic hepatectomies from living adult donors for adult and teenage recipients. The group is one of three such teams in the world, and the only one in the United States, to have reported successful procedures.

“This is a small step, but I think a useful one,” says Dr. Samstein. “We’re at the forefront of perhaps a new era for living-donor liver transplants.”

Because of a nationwide shortage of organs from deceased donors, living donors are an important source of organs to aid patients living with end-stage organ disease, particularly of the liver and kidneys. Yet only about 4 percent of liver transplants are done with a living donor, compared with nearly 50 percent of kidney transplants.

One factor in the discrepancy may be the surgical technique used to remove the organ. More than 90 percent of living-donor kidney transplants are done laparoscopically, says Dr. Samstein, while most liver donor surgeries are still done through complex open surgery. The traditional open procedure leaves the donor with a greater risk of postoperative mortality, morbidity, and pain and a longer recovery period that lasts, on average, eight to 12 weeks, two to three times longer than the recovery period for a laparoscopic kidney donor.

In 2009, Columbia surgeons began doing fully laparoscopic hepatectomies on adult donors for transplantation into children. Pediatric recipients require 15 percent to 20 percent of a healthy adult liver for transplant, but adult recipients need 30 percent to 60 percent, necessitating a more central cut through the donor liver.

The American Journal of Transplantation article detailed two living adult donors who underwent laparoscopic surgery to donate portions of their livers to adult family members. In these two cases, donor recovery time was half that of open-surgery donation with no additional postoperative donor complications. The donors also appeared to have less pain and lower risk of postsurgical hernia.

The authors caution that this procedure should be performed only in select cases and only by teams with significant experience in both living-donor procedures and laparoscopic liver surgery, as laparoscopic hepatectomies require specific training.

“Donor safety continues to be paramount, and the adoption of new surgical techniques ultimately needs to demonstrate that it meets the safety standard of old techniques before adopted,” they wrote.

NewYork-Presbyterian/Columbia remains the only center in the country performing fully laparoscopic living-donor hepatectomies for transplant into both pediatric and adult recipients.

“Clinical innovation and scientific progress constitute the core of the Center for Liver Disease and Transplantation’s mission,” says Jean C. Emond, MD, the Thomas S. Zimmer Professor of Reconstructive Surgery (in Pediatrics). Dr. Emond was a member of the team that pioneered living-donor liver transplantation, which is now considered one of the most important advances in the treatment of severe liver disease.

This article was published in the Spring 2014 issue of Columbia Medicine magazine.