Selection of a right posterior sector graft for living donor liver transplantation

Abstract

Right posterior sector (RPS) grafts have been used to overcome graft size discrepancies, the major concern of living donor liver transplantation. Previous studies have reported the volumetry-based selection of RPS grafts without anatomical exclusion. We reviewed our data and established selection criteria for RPS grafts. The procurement of RPS grafts [conventional (n 5 3) and extended (n 5 5)] was performed for 8 of 429 recipients at our center. Extended RPS grafts contained the drainage area of the right hepatic vein. The mean graft weight (GW) according to 3-dimensional computed tomography volumetry was 488 g, and the GW/standard liver weight (SLW) ratio was 42.6%. The mean actual GW was 437 g, and the GW/SLW ratio was 38.4%. One donor exhibited standard bifurcation of the right portal vein (PV) and the left PV, and 2 donors exhibited trifurcation of the left PV, the right anterior portal vein (APV), and the posterior PV. The remaining 5 donors exhibited APV branching from the left PV, which is the most suitable anatomy for RPS grafts. Two recipients died of sepsis or small-for-size graft syndrome. One underwent retransplantation because of an intractable bile leak and fibrosing cholestatic hepatitis. Intractable bile duct (BD) stenosis developed in 4 of the 6 survivors. In conclusion, with the significant complications and potential concerns associated with RPS grafts, these grafts should be used very rarely and with extreme caution. See Editorial on Page 1019Since a 1994 report demonstrating successful living donor liver transplantation (LDLT) between adults, 1 living donors have been increasingly used because of the disparity between the demand and the supply.Right lobe (RL) grafts, which account for >60% of the total liver mass, are the allografts most commonly used for LDLT. Although our previous reports have indicated an average hospital stay of <14 days and the performance of living donation without the need for nonautologous blood transfusions, 2,3 serious donor complications and death are possible. In the

Correlation Between Portal Vein Anatomy and Bile Duct Variation in 407 Living Liver Donors

“…In addition, we found that types 2 and 3 BDs are mostly associated with a supraportal RPBD, whereas type 4 BDs are mostly associated with an infraportal RPBD. Yoshizumi et al (20) reported that donors with a supraportal BD are unsuitable candidates for right posterior sector grafts. Another study revealed that biliary complications occurred in 0% of grafts including the infraportal RPBD compared with 52.6% of grafts including a short stump of the supraportal RPBD (21).…”

Use of a Right Lateral Sector Graft in Living Donor Liver Transplantation Is Feasible, but Special Caution Is Needed With Respect to Liver Anatomy

“…In contrast, the rate of major complications in the recipients was 29%, and the overall mortality rate was 6%. The causes of death at our institution were HAT and acute respiratory distress syndrome, whereas causes of death were sepsis and small-for-size syndrome in the patient series reported by Yoshizumi et al (11).…”

“…A systematic literature search identified four reports on LDLT using RLSGs (Table 3) (10,11,21,22). Together with our experience, of the 66 donors undergoing surgery for RLSG procurement, there were no operation-related deaths.…”

“…RLG or LLG) was not feasible (8,9). After our initial report, several specialized centers began to carry out RLSG procurement for LDLT (10,11); however, because of the relatively rare indication and the technical difficulties of RLSG procurement, technical tips and evidence concerning its feasibility are still insufficient. In this study, we reported the largest experience of RLSG use in LDLT and evaluated the feasibility of this relatively new technique through a systematic review of the literature.…”

Safety using small grafts: Eastern perspective

“…This outcome should be similar to when a larger graft is used. Because right lobe graft donation is associated with higher frequencies of donor complications, the use of the left lobe and right posterior sector grafts has gained wider acceptance despite the grafts being of smaller size. The use of a left lobe graft is preferred because of favorable anatomical considerations compared to a right lobe graft.…”