In this issue of HSN, the very reputed Kaohsiung Liver Transplantation Center in Taiwan led by Prof. Chao-

HepatoBiliary Surg Nutr 2019 | http://dx.doi. org/10.21037/hbsn.2019. 10.30 In this issue of HSN, the very reputed Kaohsiung Liver Transplantation Center in Taiwan led by Prof. ChaoLong Chen reports about its extensive experience in the field of adult living donor liver transplantation (aLDLT). This paper gives a strong and very important message to the liver transplant community: excellent results can only be generated in LDLT when such program is developed carefully giving thereby attention to every possible detail during all steps of the donor and recipient procedures. Such attitude not only improves the quality of the surgical and medical care given to both donor and recipient but also allows, later on, an in-depth analysis of the obtained results.closing thereby the circle necessary to further raise the performance level of the team. LDLT was introduced in clinical practice, first in 1989 by Strong and Tanaka in children, later on in 1993 by the Tanaka and Makuuchi teams in adults (1-3). It became rapidly clear that this formidable undertaking was very successful in small recipients but less so in larger (adult) recipients. In order to reduce the incidence of liver failure in the recipient, right-liver donation became, despite its documented higher morbidity, the preferred option (85–90%) in LDLT (4,5). The shift of the risk of the procedure from the recipient to the donor however hindered the widespread use of LDLT, especially in the Western world where LDLT represents only around 5% of all LT activity (6). The problems leading to reduced graft and patient survival rates in aLDLT were a source of intensive experimental and clinical research during the last two decades (7,8). The unfavourable events encountered in donor and recipient became one by one unravelled. The Kyoto team paved the way by identifying the concepts of ‘small for size graft and syndrome’ and of ‘graft hemodynamics” (9-11). Precise determination of graft and recipient anatomy and weight, modulation of inand outflow of the allograft at implantation, precise monitoring of fluid balance by the anesthesiologist (surgical) intensivists and finally perfection of the peri-operative care slowly but surely closed the “outcome gap” between the small left-liver and the large right-liver LDLT procedures (12). Several teams managed to overcome the shortcomings caused by the use of small liver grafts and so proposed to turn back the clock. It was time to ‘shift the risk from the donor to the recipient’ fulfilling thereby the main ethical concern of LDLT, to guarantee maximal safety of the donor.who in fact is not a patient (! ) but a healthy human carrying out the highest possible act of human solidarity (13-15). Left-liver retrieval, although considered (as confirmed in this paper) more difficult and time-consuming, enhances donor safety by leaving a larger residual liver volume. The key question which immediately comes up is if results of both graft types can be(come) equalized in donor and recipient? This fundamental question has been addressed in the Huang et al.’s paper (16) which excels by the way the “transplant center” and the “donor and recipient LDLT procedures” have been set up and by the way the analysis has been conducted. All analysed data are interpreted based on internationally accepted criteria such as the definition of post-hepatectomy liver failure and biliary leak following Editorial