Characteristics of Liver Grafts in Living-Donor Adult Liver Transplantation

Abstract

Hypothesis: Few studies have investigated the results of research focused on living-donor adult liver transplantation. Different characteristics between right-and leftlobe grafts have not yet been clarified in living-donor adult liver transplantation. Left-lobe graft remains an important option, even in adult recipients. Setting: A single liver transplantation center with a long history of hepatic resection. Patients: Forty-five donors received left-lobe (n=39) and right-lobe (n=6) grafts. The clinicopathological data for the donor, graft, and recipient were compared. All leftlobe 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 rightlobe graft group. We found no difference in terms of the incidence of postoperative complications between groups. No difference in induced complications of smallfor-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 rightlobe 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.

Effects of Hemi-Portocaval Shunts For Inflow Modulation on the Outcome of Small-for-Size Grafts in Living Donor Liver Transplantation

“…The technical complexity of the use of right-lobe grafts (necessity of adequate venous drainage, frequent vascular and biliary anatomical variations complicating the implantation technique), and the presumed reduced donor morbidity are arguments which could advocate the use of left-lobe grafts in adults (35). This advantage of LL donation has been shown by an Asian survey, but not confirmed in the Western countries, presumably due to the small number of procedures performed (11,(35)(36)(37). The European Liver Transplant Registry displayed indeed only a 1-year overall graft survival rate of 41% for left lobes vs. 73% for right lobes but, to our knowledge, no graft inflow modulation was used in these patients (12).…”

The outcome of living donor liver transplantation with prior spontaneous large portasystemic shunts

“…Previous studies indicated that the size of the graft liver correlates with clinical outcome [21][22][23][24]. Kiuchi et al [22] reported that the graft survival rate in patients with GRWR of <0.8% was significantly worse than with larger GRWR.…”

Adult living donor transplants-which portion of the liver to use?

“…Still, a right hepatectomy involves removing a larger mass of the liver and likely entails greater surgical stress for the recipient. In the series by Shimada et al, 3 rightlobe donors had greater serum aspartate aminotransferase and bilirubin levels postoperatively and longer hospital stays. Similar findings were noted in a nondonor model with patients undergoing hepatic resection for malignancy 4 ; recovery of liver function, according to laboratory test results, was slower and morbidity was greater in the right (versus left) hepatectomy patients.…”

“…In an earlier report by Ben-Haim et al 2 of 10 left-lobe recipients, 4 patients (40%) had small-for-size syndrome; of 30 right-lobe recipients, only 1 (3.3%) had a similar problem. Even in the series of Shimada et al, 3 of 39 left-lobe recipients, 12 (30.8%) had persistent hyperbilirubinemia (defined as serum bilirubin Ͼ 10 mg/dL on posttransplant day 14). That rate of hyperbilirubinemia was equivalent to the rate in their 6 right-lobe recipients, yet is higher than results generally reported in the literature for right-lobe recipients.…”