Right lobe donor hepatectomy: is it safe? A retrospective study

Abstract

Donor safety is utmost important in Living donor liver transplantation (LDLT). Small for size syndrome in some recipients with left lobe donors led to the evolution of right lobe LDLT. The aim of the study was to analyze the safety of large series of right lobe (RL) donor hepatectomies and compare outcomes with left lobe (LL) and left lateral segment (LLS) donations. A consecutive cohort of 726 donors from January 2011 to January 2014 were studied; RL (n = 641, 88.3%), LL (n = 36, 4.9%) or LLS (n = 49, 6.8%) depending on the type of donation. The mean age was 34.6 ± 10 years. The overall complication rate was 22.3%. Most were Clavien grade I and II. Clavien grade IIIa, IIIb, IV and V were noted in 4.2% donors. The incidence of these major complications were comparable among RL (n = 28, 4.2%), LL (n = 1, 2.7%) and LLS (n = 2, 4.08%) (P = 0.89). Bile leak was seen in 20 donors (2.7%) and 13 were managed conservatively with prolonged or additional intra-abdominal drainage. Seven underwent re-exploration for bile leak. In centres experienced in right lobe LDLT, morbidity after RL donation is similar to that of LL donation; and with adequate GRWR, same 1-year recipient outcomes.

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

“…The actual GRWR was considered while deciding the method of PIM. The recipient operative and posttransplant management protocols have been previously described . Venous outflow was fully reconstituted among all living donor right lobe (RL) grafts, either by neo–middle hepatic vein (MHV) reconstruction draining all of the anterior sector segmental outflow veins (modified) or by retaining partial MHV or subtotal MHV with the graft (shown in Tables and ), as detailed in our recent publications …”

Readdressing the Middle Hepatic Vein in Right Lobe Liver Donation: Triangle of Safety

“…The consequences may be immediate liver dysfunction, graft rupture, SFSS, and graft loss . The preexisting intrahepatic collaterals are present up to 20% and do not fully open until a second postoperative week, which is a long enough time for the graft to sustain an injury …”

“…This study was approved by the institutional review board (institutional review board number MICR‐782/2017). Preoperative donor and recipient selection criteria have been described elsewhere previously …”

A retrospective comparative study of venous vs nonringed expanded polytetrafluoroethylene extension grafts for anterior sector outflow reconstruction in right lobe living donor liver transplantation

“…This study was approved by the Institutional Review Board and conducted in accordance with the Declaration of Helsinki (IRB No: MICR‐783/2017). The details of the donor and recipient selection have been described elsewhere . Informed written consent was taken from all the donors about the risks associated with the procedure.…”