ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), in Palermo, has performed its 100th adult living-donor liver transplant. The transplant was performed on October 13, 2015. The donor left the hospital after only 10 days, and the transplant recipient was discharged home today.
The patient is a Sicilian woman from Catania. The man who donated 60% of his liver was her husband, C.M., who has allowed his wife to return to a good quality of life. “I decided immediately to donate a part of me to my wife,” he said. “I made the decision two years ago, and that decision was dictated by love."
The woman had been waiting for a transplant for two years, and she had been called in for a transplant twice, but both times the procedure was cancelled because the organs were not suitable. “Being able to alleviate my wife's pain was a great gift,” her husband said. “It is important that other people going through the same ordeal know that this possibility exists, and that there is a hospital in Palermo, ISMETT, where very well trained and professional staff work."
In Italy, living-donor liver transplantation is regulated by the National Transplantation Center, which authorizes this kind of surgery only for centers that have transplant survival rates in line with the best European centers. “For patients with an end-stage organ disease,” according to Salvo Gruttadauria, head of the living-donor liver transplantation program at ISMETT, “transplantation is the only possibility to survive and significantly improve their quality of life. A living-donor transplant is an alternative therapeutic option when the patient's health conditions do not allow further wait on the transplant list."
From a surgical point of view, a living-donor transplant is possible thanks to the ability of the liver to regenerate. The liver can be split in two and, 3-4 weeks after surgery, it returns to its normal size both in the donor and recipient. Each lobe has its own arterial and venous vascularization, and they drain bile through two main ducts that join at their distal portion right outside the liver. In an adult patient, the right lobe, i.e., the largest portion, accounting for 60% of the liver, is procured. In a pediatric patient, the left lobe, i.e., the smallest portion of the organ, is procured.
This is a very complex and delicate operation, which puts the donor at risk of all surgical complications usually associated with a major liver resection or general anesthesia. To minimize the risks for the donor, and optimize the outcome for the recipient, this type of surgery is performed in only a few specialized centers, and by two teams with specific surgical experience. In order to protect the health of the donor and minimize the risks, strict donor selection criteria are being applied at ISMETT.
Before surgery, donors undergo extensive clinical assessment to determine whether their physical and mental health allow them to undergo such complex surgery. After this assessment, if there are no contraindications, the donation, with its risks and benefits, is also discussed with the patient's general practitioner.
The first living-donor liver transplant at ISMETT was performed in 2002. In addition to the 100 living-donor liver transplants performed in adult patients, 15 have been performed in pediatric patients.