Right Lobe Graft in Living Donor Liver Transplantation

115

116

Graft size problems remain the greatest limiting factor for expansion of living donor liver transplantation (LDLT) to the adult population. The result of adult-to-adult LDLT using the left lobe with special reference to graft size has not been fully evaluated to date. In this study, we evaluated the outcome of adult-to-adult LDLT using the left lobe and also analyze the impact of using small-for-size grafts on outcome. Thirty-six recipients who underwent adult-to-adult LDLT using the left lobe (n ‫؍‬ 14) or left lobe plus caudate lobe (n ‫؍‬ 22) were included in the study. Variables including preoperative and operative data, patient and graft survival, complications, and causes of graft loss were studied. Furthermore, the incidence of small-for-size syndrome and its impact on graft survival were studied. Mean graft volume (GV) was 420 ؎ 85 g (range, 260 to 620 g), which resulted in 38.2% ؎ 8.1% (range, 22.8% to 53.8%) of the recipient standard liver volume (SLV). Overall 1-year patient and graft survival rates were 85.7% and 82.9%, respectively. Seven grafts were lost. Small-for-size syndrome occurred in 7 of 16 patients (43.8%) with cirrhosis and only 1 of 20 patients (5.0%) without cirrhosis (P ‫؍‬ .005). Recipients who developed small-for-size syndrome had inferior graft survival to those who did not (P ‫؍‬ .07). In conclusion, adult-to-adult LDLTs were found to be feasible without affecting patient or graft survival. Small-for-size syndrome developed more frequently in patients with cirrhosis. Minimum GV in adult-to-adult LDLT should be 30% less than the recipient's SLV in patients without cirrhosis, whereas 45% less was required in patients with cirrhosis. (Liver Transpl 2003;9:581-586.)

Section: Discussionmentioning

confidence: 99%

Outcome analysis in adult-to-adult living donor liver transplantation using the left lobe

Soejima

Shimada

Suehiro

et al. 2003

115

116

“…Although morbidity for right-lobe liver donation generally is considered to be low, many believe the true complication rate is underestimated. 10,11,24 In December 2000, The National Institutes of Health sponsored an international workshop reviewing the sci-S46 entific, medical, and psychosocial issues associated with LDALT in an attempt to improve the success and applicability of this procedure. An overall morbidity rate of 21% was estimated based on results of several large series of right-and left-lobe living donors in the world literature.…”

Section: Donor Morbiditymentioning

confidence: 99%

Early and late complications in the right-lobe adult living donor

Pomfret

2003

Key Points 1. Reported complication rates for right-lobe liver donors vary widely, but are estimated to be approximately 35%, with a surgical mortality rate of approximately 0.3%. 2. Biliary complications, including leak, biloma, or stricture, are the most commonly reported morbidity in rightlobe living donors. 3. Other significant donor morbidity includes portal vein thrombosis, pulmonary embolus, bowel obstruction, bleeding requiring reoperation or transfusion, and incisional hernia. 4. These data underscore the reality that living donation is associated with a small, but real, possibility of death and potentially significant morbidity, emphasizing the need for a comprehensive database to precisely define true living donor morbidity and mortality. (Liver Transpl 2003; 9:S45-S49.)

“…The procedure was performed without hepatic inflow occlusion during the parenchymal transection and according to the standards described by Inomata et al 15 All of the grafts were weighed after flushing/ cooling on the back table.…”

Section: Donor Liver Graftmentioning

confidence: 99%

Changes in portal vein flow after adult living-donor liver transplantation: Does it influence postoperative liver function?

García-Valdecasas

2003

In adult living donor liver transplantation, using small grafts in cirrhotic patients with severe portal hypertension may have unpredictable consequences. The so-called small-for-size syndrome is present in most series worldwide. The goal of this study was to prospectively evaluate the influence of hemodynamic changes on postoperative liver function and on the percentage of liver volume increase, in the setting of living donor liver transplantation. Twenty-two consecutive adult living donor liver transplantations were performed at our institution in a 2-year period. We measured right portal flow and right hepatic arterial flow with an ultrasonic flow meter in the donor, and then in the recipient 1 hour after reperfusion. Postoperative liver function was measured by daily laboratory work. We also performed duplex ultrasounds on postoperative days 1, 2, and 7. Liver volume increase was estimated by magnetic resonance imaging graft volumetry at 2 months posttransplantation. We compared the blood flow results with the immediate liver function and its liver volume increase rate at 2 months. There was a significant increase in portal flow in the recipients compared with the donors (up to fourfold in some cases). Higher portal flow increase rates significantly correlated with faster prothrombin time normalization and faster liver volume increases. Median graft volume increase at 2 months was 44.9%. The increase in blood flow to the graft is well tolerated by the liver mass not affecting hepatocellular function as long as the graft-to body weight ratio is maintained (>0.8) and adequate outflow is provided. (Liver Transpl 2003;9:564-569.)