Leaning to the Left

Halazun, Karim J.; Przybyszewski, Eric M.; Griesemer, Adam; Cherqui, Daniel; Michelassi, Fabrizio; Guarrera, James V.; Kato, Tomoaki; Brown, Robert S.; Emond, Jean C.; Samstein, Benjamin

doi:10.1097/sla.0000000000001860

Cited by 50 publications

(20 citation statements)

References 36 publications

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“…(23,24) Many authors favor the use of left lobe grafts, due to theoretical advantages of simpler biliary approach and superior recovery of postoperative liver function in the donor. (7,(25)(26)(27) Others find right-sided grafts, if performed in experienced centers with properly selected donor-recipient pairs, provide comparable long-term outcomes for the donor. (28)(29)(30)(31)(32) To date, there is no published meta-analysis focusing on donor outcomes following living liver donation.…”

Section: Discussionmentioning

confidence: 99%

Donor Morbidity Is Equivalent Between Right and Left Hepatectomy for Living Liver Donation: A Meta‐Analysis

et al. 2021

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Maximizing liver graft volume benefits the living donor liver recipient. Whether maximizing graft volume negatively impacts living donor recovery and outcomes remains controversial. Patient randomization between right and left hepatectomy has not been possible due to anatomic constraints; however, a number of published, nonrandomized observational studies summarize donor outcomes between 2 anatomic living donor hepatectomies. This meta-analysis compares donor-specific outcomes after right versus left living donor hepatectomy. Systematic searches were performed via PubMed, Cochrane, ResearchGate, and Google Scholar databases to identify relevant studies between January 2005 and November 2019. The primary outcomes compared overall morbidity and incidence of severe complications (Clavien-Dindo >III) between right and left hepatectomy in donors after liver donation. Random effects meta-analysis was performed to derive summary risk estimates of outcomes. A total of 33 studies (3 prospective and 30 retrospective cohort) were used to identify 7649 pooled patients (5993 right hepatectomy and 1027 left hepatectomy). Proportion of donors who developed postoperative complications did not significantly differ after right hepatectomy (0.33; 95% confidence interval [CI], 0.27-0.40) and left hepatectomy (0.23; 95% CI, 0.17-0.29; P = 0.19). The overall risk ratio (RR) did not differ between right and left hepatectomy (RR, 1.16; 95% CI, 0.83-1.63; P = 0.36). The relative risk for a donor to develop severe complications showed no differences by hepatectomy side (Incidence rate ratio, 0.97; 95% CI, 0.67-1.40; P = 0.86). There is no evidence that the overall morbidity differs between right and left lobe donors. Publication bias reflects institutional and surgeon variation. A prospective, standardized, multi-institutional study would help quantify the burden of donor complications after liver donation.

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Section: Discussionmentioning

confidence: 99%

Donor Morbidity Is Equivalent Between Right and Left Hepatectomy for Living Liver Donation: A Meta‐Analysis

et al. 2021

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“…In this early phase of NDD, in an attempt to achieve the best possible outcome for the donor and recipient as well as community acceptance of NDD, we would favor a conservative approach in consideration of acceptance of graft size and suggest >0.8 may be most appropriate. [68] • Potential recipients who have an approved yet incompatible (size or ABO) living donor should be given first priority for ND-LLD grafts and the approved donor allocated to a compatible recipient (pediatric, if available) to allow for two transplants to occur. • Pediatric recipients should share first priority for ND-LLD grafts because pretransplant mortality rate is highest for pediatric candidates, especially those aged younger than 1 year, at 12.1 deaths per 100 waitlist-years.…”

Section: A Par Adigm For Allocation Of Ndd LI Ver Gr Aftsmentioning

confidence: 99%

The use of nondirected donor organs in living donor liver transplantation: Perspectives and guidance

et al. 2022

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Interest in anonymous nondirected living organ donation is increasing in the United States and a small number of transplantation centers are accumulating an experience regarding nondirected donation in living donor liver transplantation. Herein, we review current transplant policy, discuss emerging data, draw parallels from nondirected kidney donation, and examine relevant considerations in nondirected living liver donation. We aim to provide a consensus guidance to ensure safe evaluation and selection of nondirected living liver donors and a schema for just allocation of nondirected grafts.

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“…A biliary stricture is frequently observed to be 7.3%–60% in the right lobe grafts, 24% in the left lateral segment grafts 10 and 23.8%–32.1% in the left lobe grafts. 9 , 11 …”

Section: Discussionmentioning

confidence: 99%

Endoscopic treatment of biliary complications in left lobe living donor liver transplantation

Erdoğan

Harputluoğlu

2018

TCRM

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PurposeAlmost all of the publications regarding the treatment of biliary complications after liver transplantation are related to biliary complications after right lobe living donor liver transplantation (LDLT) and cadaveric liver transplantation (LT). The number of publications regarding endoscopic treatment of biliary complications after left lobe LDLT is negligible. In this study, we aimed to present the results of endoscopic treatments applied in the management of biliary complications developed in left-lobe duct-to-duct LDLT patients.Patients and methodsBetween 2008 and 2018, patients with duct-to-duct anastomosis who underwent ERCP due to biliary complication after left lobe LDLT were included in the study. Clinical data included patient demographics, indications for LDLT, duration till the first ERCP after LDLT, number of ERCP procedures, ERCP indications (stricture or leak), and treatment outcomes, including the need for percutaneous and surgical interventions.ResultsAmong 13 patients who underwent ERCP, 2 (15%) had biliary leakage and 11 (8%) had an anastomotic stricture. Our endoscopic success rate was 100% in patients with biliary stricture. Despite the implementation of ERCP on two patients with leakage, they died due to the biliary complication.ConclusionOur results suggest that endoscopic treatment methods are successful in the management of biliary stricture complication in patients with left lobe LDLT and duct-to-duct anastomosis. Although our findings show that endoscopic treatments fail when there is a leakage after left lobe LDLT, there is a need for further studies that include more patients to reach a definite conclusion.

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Leaning to the Left

Cited by 50 publications

References 36 publications

Donor Morbidity Is Equivalent Between Right and Left Hepatectomy for Living Liver Donation: A Meta‐Analysis

Donor Morbidity Is Equivalent Between Right and Left Hepatectomy for Living Liver Donation: A Meta‐Analysis

The use of nondirected donor organs in living donor liver transplantation: Perspectives and guidance

Endoscopic treatment of biliary complications in left lobe living donor liver transplantation

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