Living-donor and split-liver transplantation in adults: right versus left-sided grafts.

The pioneers of liver transplantation established the technical aspects of orthotopic grafting and its efficacy as a treatment for endstage liver disease. Progress was hampered by rejection, but the improved immunotherapy provided by cyclosporine was followed by exponential growth in clinical liver transplantation during the 1980s, with expansion in the number of transplant centers around the world and the consequent rapid increase in the number of transplants performed. The success of the procedure, the reduction in the absolute and relative contraindications to liver transplantation, and the widening of the spectrum of disease processes deemed amenable to liver replacement led to the number of patients waiting for a liver transplant far exceeding the available donor liver grafts. Due to the paucity of whole organs from pediatric donors, this discrepancy was always present for young children, for whom there was a pretransplant mortality of greater than 25%.1 This mortality shaped the development of pediatric liver transplantation, with the introduction of reduction hepatectomy of a larger donor liver prior to engraftment into the pediatric recipient. The first reported clinical attempt at a reduced-size orthotopic liver transplant in a child was by Bismuth and Houssin in 1984.2 Modifications of the technique Living-donor and split-liver transplantation in adults: right versus left-sided grafts