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

Abstract

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.

Organ Restoration With Normothermic Machine Perfusion and Immune Reaction

“…No significant differences were seen when comparing left and right lobes for the energy ratios during the split machine perfusion model. This highlights the potential in the split technique, as we can hypothesize that both lobes will behave metabolically and physiologically in the same way (28). In essence, if each lobe has good function, we are therefore able to further increase the donor pool by utilizing what previously was one suboptimal liver allograft into two viable transplantable allografts (27,29,30).…”

Liver transplantation: expanding the donor and recipient pool

“…Graft failure is reported to occur in up to 7.8%, 14.6% and 26.5% of LDLTs at 1, 3 and 5 years with more favourable outcomes demonstrated in non-hepatocellular carcinoma (HCC) diagnoses and Model for End-stage Liver Disease (MELD) scores less than 20 (12). Furthermore, a study by She and colleagues reported, in an analysis of 218 patients, significantly better 5-year graft survival rates in using right lobe LDLT, albeit comparable 5-year patient survival rates (54). These findings were contrasted by Olthoff and colleagues who in a large multicentre study of 963 LDLTs demonstrated similar graft survival rates in right and left lobe LDLTs with decreasing rates of graft failure associated with greater centre experience (55).…”

Feasibility of using marginal liver grafts in living donor liver transplantation

“…Accordingly, the accepted arbitrary requirement for GRWR was reduced to 0.8%, and the GV/SLV value was 40%[ 11 , 12 ]. As many transplantation centers accumulated experience on small-for-size grafts for LDLT, grafts with a GRWR < 0.8% were used and reported to be as safe as those with a GRWR ≥ 0.8%[ 13 - 17 ]. After challenging the boundary of GRWR = 0.8%, the acceptable minimum GRWR has been continuously lowered.…”