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The long-term outcomes of patients with hepatocellular carcinoma after living donor liver transplantation: a comparison of right and left lobe grafts

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Abstract

Purpose

The feasibility of living donor liver transplantation (LDLT) using left lobe (LL) grafts has been demonstrated. However, the long-term outcome of the hepatocellular carcinoma (HCC) patients with LL grafts has not been elucidated. The aim of this study was to analyze the long-term outcomes after LDLT for HCC according to the graft type.

Methods

A retrospective analysis was performed evaluating the outcomes of LL graft recipients (n = 82) versus recipients of RL grafts (n = 46). The analysis endpoints were the overall and recurrence-free survival after LDLT. The demographics of both recipients and donors, and the tumor characteristics associated with the graft type were also analyzed.

Results

The graft volume (436 ± 74 g), as well as the graft volume-standard liver volume rate (38.3 ± 6.2%) of the LL graft group were significantly decreased as compared to those of the RL graft group (569 ± 82 g, 46.3 ± 6.7%; p < 0.01). The 1-, 3-, 5- and 7-year overall survival rates of the LL graft group were 88.2, 80.2, 75.7 and 72.4%, respectively, which were not significantly different compared to those of the RL graft group (95.4, 87.3, 87.3 and 87.3%). The recurrence-free survival rates of the LL graft group (89.1% at 1 year, 78.8% at 3 years, 75.8% at 5 years and 70.3% at 7 years) were similar to those of the RL graft group (88.6, 88.6, 88.6 and 88.6%). The mean peak postoperative total bilirubin levels and duration of hospital stay after surgery for the LL grafting donors were significantly decreased as compared to those of the RL grafting donors (p < 0.01). The rate of severe complications (over Clavien’s IIIa) associated with LL graft procurement was 6.2%, which was lower than that in the RL graft group (15.6%).

Conclusions

The long-term outcomes in the HCC patients with LL grafts were similar to those of patients receiving RL grafts, and the outcomes of the donors of LL grafts were more favorable. Therefore, LL grafts should be considered when selecting LDLT for HCC to ensure donor safety.

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Abbreviations

AFP:

Alpha-fetoprotein

CL:

Caudate lobe

CT:

Computed tomography

DCP:

Des-gamma-carboxy prothrombin

DDLT:

Deceased donor liver transplantation

GRWR:

Graft-recipient weight ratio

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

LDLT:

Living donor liver transplantation

LL:

Left lobe

LT:

Liver transplantation

MMF:

Mycophenolate mofetil

RL:

Right lobe

RV:

Remnant liver volume

SLV:

Standard liver volume

TLV:

Total liver volume

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Acknowledgments

We thank Professor Brian Quinn for his review of this manuscript.

Conflict of interest

None of the authors has any conflict of interest.

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Authors and Affiliations

  1. Department of Surgery and Science, Graduate School of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Akinobu Taketomi, Ken Shirabe, Takeo Toshima, Kazutoyo Morita, Naotaka Hashimoto, Hiroto Kayashima, Tohru Ikegami, Tomoharu Yoshizumi, Yuji Soejima & Yoshihko Maehara

Authors
  1. Akinobu Taketomi
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  2. Ken Shirabe
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  3. Takeo Toshima
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  4. Kazutoyo Morita
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  5. Naotaka Hashimoto
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  6. Hiroto Kayashima
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  7. Tohru Ikegami
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  8. Tomoharu Yoshizumi
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  9. Yuji Soejima
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  10. Yoshihko Maehara
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Corresponding author

Correspondence to Akinobu Taketomi.

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Taketomi, A., Shirabe, K., Toshima, T. et al. The long-term outcomes of patients with hepatocellular carcinoma after living donor liver transplantation: a comparison of right and left lobe grafts. Surg Today 42, 559–564 (2012). https://doi.org/10.1007/s00595-011-0086-4

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  • DOI: https://doi.org/10.1007/s00595-011-0086-4

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