Safety of donor right hepatectomy for adult-to-adult living donor liver transplantation

Abstract

Summary The purpose of this study was to ascertain the usefulness of preoperative evaluations of donors by computed tomography (CT) volumetry and CT cholangiography for prevention of unexpected liver failure and biliary complications after donor right hepatectomy for adult‐to‐adult living donor liver transplantation. Fifty‐two donors who underwent right hepatectomy without the middle hepatic vein were enrolled in this study. The values of graft weight (GW) were significantly correlated with those of estimated graft volume (GV; P < 0.0001). GW was predicted by the following formula: GW = 155.25 + 0.658 × GV; r2 = 0.489. CT cholangiography revealed anatomical variants of biliary structure in one‐third of the donors and also clearly showed one or two small biliary branches from the caudate lobe to the right hepatic ducts or the confluence in 58% of the donors. Biliary leakage, which was treated by conservative therapy, occurred in only one donor (1.9%). No donors received homologous blood transfusion. Hyperbilirubinemia (serum total bilirubin >5 mg/dl) occurred in 5.8% of the donors during their early postoperative periods. Precise evaluations of liver remnant volume by CT volumetry and biliary variation by CT cholangiography are essential for performing safe donor hepatectomy, preventing hepatic insufficiency and minimizing the risk of biliary tract complications.

Safety and Feasibility of Diet-Treated Donors With Steatotic Livers at the Initial Consultation for Living-Donor Liver Transplantation

“…The selection criteria for donors, including laboratory data and imaging studies, the surgical procedure, and the postoperative management for donor hepatectomy have been described elsewhere (35). Recipient surgery has also been described previously (36).…”

Donor Complications Including the Report of One Death in Right-Lobe Living-Donor Liver Transplantation

“…Right lobectomy for adult-to-adult LDLT, a more complex and challenging procedure, was successfully performed by Yamaoka et al[ 3] in Japan in 1994. This was followed by an extensive debate by the medical community regarding the safety and ethics of LDLT [4,5,6,7,8]. …”

Karaciğerin ve Safra Yollarının Radyolojik Anatomisi

“…BT-kolanjiografi veya MR-kolanjiografi ile preoperatif radyolojik değerlendirme yapılan olgularda, varyasyonlar nedeniyle oluşan komplikasyonların büyük ölçüde engellenebileceği gösterilmiştir [35]. İntravenöz kolanjiografik kontrast madde verilmesini takiben yapılan BT-kolanjiografinin, intrahepatik safra yolları anatomisini görüntü-lemede MR-kolanjiografiden daha üstün olduğu belirtilmektedir [36].…”