A New Approach for Increasing Availability of Liver Grafts and Donor Safety in Living Donor Liver Transplantation: LD-RAPID Procedure in the Cirrhotic Setting With Hepatocellular Carcinoma

One of the main limitations of Living Donor Liver Transplantation (LDLT) is the availability of donors with adequate liver volume. Here, we describe a novel approach inspired by the LD-RAPID (Living Donor - Resection And Partial Liver Segment 2-4 Liver Transplantation With Delayed Total Hepatectomy) Procedure, a two-stage hepatectomy with partial liver transplantation, first described for patients with colorectal liver metastases. The patient was a 49 year-old woman, with cirrhosis and a 3 cm mass consistent with HCC. She weighed 88 kilograms (kg) with a BMI of 35. Her only donor, a 43-year-old man, with an estimated left lobe of 24% of total liver volume and an estimated GRWR of 0.41 for the Left-Lobe (LL) LDLT. In the first stage; a left lateral sectionectomy and orthotopic LL LDLT (314grams, GRWR:0.35) was performed with a hemi-portacaval shunt formation. Twenty-two days after first stage graft volume reached to 490 ml (GRWR.0.6), (60% increase) that is followed by the completion of resection of remnant diseased liver with shunt closure. The patient recovered uneventfully and doing well 1 year after LL LDLT no evidence of tumor recurrence. This is the first reported case of the Rapid procedure in the cirrhotic setting with hepatocellular carcinoma which can potentially provide a timely curative treatment for patients with cirrhosis who have limited donor options.