Right Posterior Sector Graft for Living-Donor Liver Transplantation

Abstract

In Australia in 1989, Strong et al. [1] reported the first case of a living-donor liver transplantation (LDLT), a procedure that has been subsequently heavily promoted in Asia due to scarce donations in this region. At first, to ensure the safety of the donations, LDLT was only undertaken in children, who received a left lateral liver or left lobe transplant. However, for adults with end-stage liver diseases, the left lobe was insufficient as a graft and was only used in low-weight patients. In 1994, Kyoto University [2] reported the first liver transplantation using a right lobe graft, which was donated to a 9-year-old patient with biliary atresia. Although the right lobe was selected due to a variation of the left hepatic artery rather than a consideration of donor liver volume, this report provided strong evidence for the safety of a right lobe graft. Adult patients comprised the majority of patients with end-stage liver diseases many years; thus, LDLT with a right lobe graft between adults decreased the mortality for these patients waiting for livers. For this reason, LDLT has become important in the context of liver transplantations in adults. Nonetheless, the risks of surgery for donors increased, while the complication rate decreased in the recipients when a right lobe instead of left lobe hepatectomy was undertaken. Some cases have even reported donors with liver failure or death. For example, Surman et al. [3] reported seven cases of donor mortality. Moreover, two donors accepted liver transplantation after resection due to the deficiency of the residual liver volume.