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Adult living donor transplants‐which portion of the liver to use?
Author(s) -
Humar Abhi
Publication year - 2003
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.500090619
Subject(s) - medicine , surgery , lobe , liver transplantation , gauche effect , ascites , transplantation , left lobe , anatomy
Hypothesis: Few studies have investigated the results of research focused on living donor adult liver transplantation. Different characteristics between right‐ and left‐lobe grafts have not yet been clarified in living‐donor adult liver transplantation. Left‐lobe grafts remain an important option, even in adult recipients. Setting: A single liver transplant center with a long history of hepatic resection. Patients: Forty‐five donors received left‐lobe (n = 39) and right‐lobe (n = 6) grafts. The clinicopathologic data for the donor, graft, and recipient were compared. All left‐lobe grafts were extended grafts that included the middle hepatic vein, and 24 of the 39 left‐lobe grafts included the left caudate lobe. No right‐lobe graft included a middle hepatic vein. Results: The postoperative aspartate aminotransferase and total bilirubin values of the donor in the right‐lobe graft group were higher, and the postoperative hospital stay was longer than in the left‐lobe graft group. Graft weight in the left‐lobe graft group was lighter than in the right‐lobe graft group (median weight, 450 vs 675 g). The median graft weight divided by the standard liver volume in the left‐lobe graft group was 41% (range, 21%‐66%), compared with 52% (range, 47%‐75%) in the right‐lobe graft group. We found no difference in terms of the incidence of postoperative complications between groups. No difference in induced complications of small‐for‐size grafts such as intractable ascites and persistent hyperbilirubinemia was evident between groups. The survival rate for grafts at 18 months was 75.0% in the right‐lobe graft group compared with 85.6% in the left‐lobe group. In the right‐lobe graft group, we found a few cases in which a marked poor‐perfusion area in the anterior segment caused liver dysfunction. Conclusions: Left‐lobe grafts are a feasible option for living‐donor adult liver transplantation, and in the case of right‐lobe grafts, hepatic venous drainage is one of the most critical problems.