Left lobe living donor liver transplantation in adults: What is the safety limit?

Ikegami, Toru; Yoshizumi, Tomoharu; Sakata, Kazuhito; Uchiyama, Hideaki; Harimoto, Norifumi; Harada, Noboru; Itoh, Shinji; Nagatsu, Akito; Soejima, Yuji; Maehara, Yoshihiko

doi:10.1002/lt.24611

Cited by 61 publications

(67 citation statements)

References 33 publications

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“…The current study found that SFS RL graft and SFS LL graft did not have much difference when patient survival is concerned - which echoes the results in the literature[38,39] - but the SFS RL grafts had better survival than the SFS LL grafts ( P = 0.049). This study is a single-center retrospective study.…”

Section: Discussionsupporting

confidence: 87%

Outcomes of right-lobe and left-lobe living-donor liver transplantations using small-for-size grafts

She¹,

Chok²,

Chan³

et al. 2017

WJG

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AIMTo analyze the outcomes of living-donor liver transplantation (LDLT) using left-lobe (LL) or right-lobe (RL) small-for-size (SFS) grafts.METHODSProspectively collected data of adult patients who underwent LDLT at our hospital in the period from January 2003 to December 2013 were reviewed. The patients were divided into the RL-LDLT group and the LL-LDLT group. The two groups were compared in terms of short- and long-term outcomes, including incidence of postoperative complication, graft function, graft survival, and patient survival. A SFS graft was defined as a graft with a ratio of graft weight (GW) to recipient standard liver volume (RSLV) (GW/RSLV) of < 50%. The Urata formula was used to estimate RSLV.RESULTSTotally 218 patients were included for analysis, with 199 patients in the RL-LDLT group and 19 patients in the LL-LDLT group. The two groups were similar in terms of age (median, 53 years in the RL-LDLT group and 52 years in the LL-LDLT group, P = 0.997) but had significantly different ratios of men to women (165:34 in the RL-LDLT group and 8:11 in the LL-LDLT group, P < 0.0001). The two groups were also significantly different in GW (P < 0.0001), GW/RSLV (P < 0.0001), and graft cold ischemic time (P = 0.007). When it comes to postoperative complication, the groups were comparable (P = 0.105). Five patients died in hospital, 4 (2%) in the RL-LDLT group and 1 (5.3%) in the LL-LDLT group (P = 0.918). There were 38 graft losses, 33 (16.6%) in the RL-LDLT group and 5 (26.3%) in the LL-LDLT group (P = 0.452). The 5-year graft survival rate was significantly better in the RL-LDLT group (95.2% vs 89.5%, P = 0.049). The two groups had similar 5-year patient survival rates (RL-LDLT: 86.8%, LL-LDLT: 89.5%, P = 0.476).CONCLUSIONThe use of SFS graft in LDLT requires careful tailor-made surgical planning and meticulous operation. LL-LDLT can be a good alternative to RL-LDLT with similar recipient outcomes but a lower donor risk. Further research into different patient conditions is needed in order to validate the use of LL graft.

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Section: Discussionsupporting

confidence: 87%

Outcomes of right-lobe and left-lobe living-donor liver transplantations using small-for-size grafts

She¹,

Chok²,

Chan³

et al. 2017

WJG

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“…Because it was ensured that the postperfusion PP was <18 mm Hg in all low-GRWR grafts, it is not surprising that the PP was not found to be a significant factor in their outcome. Others have also found MELD, (45,46) age, (47) and PP (5) to be important in this situation. Unlike in some other studies, (14,38) PF was not an important determinant of outcome of low-GRWR grafts in our study.…”

Section: Discussionmentioning

confidence: 89%

Is Portal Inflow Modulation Always Necessary for Successful Utilization of Small Volume Living Donor Liver Grafts?

et al. 2019

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Although the well‐accepted lower limit of the graft‐to‐recipient weight ratio (GRWR) for successful living donor liver transplantation (LDLT) remains 0.80%, many believe grafts with lower GRWR may suffice with portal inflow modulation (PIM), resulting in equally good recipient outcomes. This study was done to evaluate the outcomes of LDLT with small‐for‐size grafts (GRWR <0.80%). Of 1321 consecutive adult LDLTs from January 2012 to December 2017, 287 (21.7%) had GRWR <0.80%. PIM was performed (hemiportocaval shunt [HPCS], n = 109; splenic artery ligation [SAL], n = 14) in 42.9% patients. No PIM was done if portal pressure (PP) in the dissection phase was <16 mm Hg. Mean age of the cohort was 49.3 ± 9.1 years. Median Model for End‐Stage Liver Disease score was 14, and the lowest GRWR was 0.54%. A total of 72 recipients had a GRWR <0.70%, of whom 58 underwent HPCS (1 of whom underwent HPCS + SAL) and 14 underwent no PIM, whereas 215 had GRWR between 0.70% and 0.79%, of whom 51 and 14 underwent HPCS and SAL, respectively. During the same period, 1034 had GRWR ≥0.80% and did not undergo PIM. Small‐for‐size syndrome developed in 2.8% patients. Three patients needed shunt closure at 1 and 4 weeks and 60 months. The 1‐year patient survival rates were comparable. In conclusion, with PIM protocol that optimizes postperfusion PP, low‐GRWR grafts can be used for appropriately selected LDLT recipients with acceptable outcomes.

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“…A major feature of ERAT is the longer CIT compared with ordinary LT (17). In addition, ERAT procedures are more complex than LT and hepatectomy so a longer operative time and more intraoperative blood loss seem inevitable (10).These are two poor prognostic indicators for LT recipients and hepatectomy patients because they may lead to graft loss due to the high incidence of postoperative biliary and arterial complications or severe hepatic dysfunction (18). Based on the above theory, the liver function, quality and estimated RLV of ELRA patients need to meet higher requirements.…”

Section: Discussionmentioning

confidence: 99%

Application of Ex Vivo Liver Resection Followed by the Autotransplantation Technique in Radical Resection of Gastric Cancer Liver Metastases: A Case Report

Wang

Zhang

et al. 2020

Preprint

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Background Radical resection of gastric cancer liver metastases can increase the 5-year survival rate of GCLM patients. However, patients may lose the theoretical feasibility of surgery due to the critical location of liver metastasis in some cases. Case presentation A 29-year-old female had a chief complaint of chronic abdominal pain for one year. Abdominal CT and MRI examinations suggested a mass of unknown pathological nature located between the first and second hila and the margin of the lower segment of the right lobe of the liver. The anterior wall of the gastric antrum was unevenly thickened. The diagnosis of (gastric antrum) intramucosal well-differentiated adenocarcinoma was histopathologically confirmed by puncture biopsy with gastroscopy guidance. The pathological properties of the liver mass remained unclear before surgery. She underwent radical resection (excision of both gastric tumors and ELRA simultaneously）followed by XELOX adjuvant chemotherapy. Without serious postoperative complications, the patient was successfully discharged on the 20th day after the operation. Pathological examination of the excised specimen indicated that gastrectomy with D2 lymph node dissection for primary gastric tumors and R0 resection for liver metastases were achieved. The resected mass was confirmed to be poorly differentiated gastric carcinoma (hepatoid adenocarcinoma with neuroendocrine differentiation) with liver metastases in segments 6 and 8. A Follow-up review that began one month after surgery showed no recurrence or metastasis within the liver. The mother of three children miraculously lived a happy life and went back to work as normal. Conclusions: Application of ELRA in radical resection for GCLM can help selected patients with intrahepatic metastases located in complex sites obtain a favorable clinical outcome.

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Left lobe living donor liver transplantation in adults: What is the safety limit?

Cited by 61 publications

References 33 publications

Outcomes of right-lobe and left-lobe living-donor liver transplantations using small-for-size grafts

Outcomes of right-lobe and left-lobe living-donor liver transplantations using small-for-size grafts

Is Portal Inflow Modulation Always Necessary for Successful Utilization of Small Volume Living Donor Liver Grafts?

Application of Ex Vivo Liver Resection Followed by the Autotransplantation Technique in Radical Resection of Gastric Cancer Liver Metastases: A Case Report

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