14th Congress of the Asian Society of Transplantation - Part II
Liver transplantation
Impact of Graft Type in Living Donor Liver Transplantation: Remnant Liver Regeneration and Outcome in Donors

https://doi.org/10.1016/j.transproceed.2015.12.123Get rights and content

Highlights

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    Dominant RHV and LLS groups have a significantly better RLRR than the RL group, but no significance in the dominant MHV group.

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    LL graft donation, especially RHV dominant donors, may have more comparable outcomes with that of RL and should be a favorable option during donor selection.

Abstract

Objectives

Liver regeneration and donor safety in right-lobe (RL) and left-lobe (LL) grafts are essential for donors in living donor liver transplantation (LDLT). Our aim was to compare the liver regeneration rate and postoperative outcome between different donor graft types in LDLT.

Materials and Methods

A total of 95 donors were divided into 2 groups: RL (n = 42) and LL (n = 53). The remnant liver of LL donors were subdivided into 3 subgroups according to the different hepatic venous drainage pattern that dominates from right hepatic vein (dominant RHV; n = 34), middle hepatic vein (dominant MHV; n = 10), and include MHV for left lateral segment (LLS) graft (n = 9). The demographic data, postoperative laboratory data, complications, remnant liver volume (RLV), and remnant liver regeneration rate (RLRR) 6 months after surgery were compared.

Results

The postoperative total bilirubin (TB), prothrombin time (PT), and intensive care unit (ICU) stays of the LL group were lower than the RL group (P < .05). The LL group has no significant better regeneration rate 6 months after surgery than the RL group. However, dominant RHV and LLS groups have significantly better RLRR than the RL group (89.2% vs 86% and 95.1% vs 86%, respectively, P < .05), but no significance in the dominant MHV group.

Conclusion

In conclusion, different hepatic venous drainage patterns of remnant liver grafts may affect the regeneration rate in LL LDLT, especially with dominant RHV donors, may have more comparable outcomes with that of RL, and should be a favorable option during donor selection.

Section snippets

Materials and Methods

From January 2013 to November 2013, 95 donors underwent hepatectomy for LDLT in Kaohsiung Chang Gung Memorial Hospital. Right hepatectomy (without MHV), left hepatectomy (with MHV), and left lateral segmentectomy were performed in 42, 44, and 9 donors, respectively. The remnant liver of LL donors were subdivided into 3 subgroups according to the territories of venous drainage, including dominant RHV (n = 34), dominant MHV (n = 10), and LLS (n = 9). The demographic data, postoperative laboratory

Results

All donors were alive and well at the end of follow-up. There was no significant difference between the 2 groups in the donor's age, transient liver enzyme elevation, operation time, postoperative minor complications, and RLRR after 6 months; however, there were significant differences in gender, body mass index (BMI), PT, TB, blood loss, and ICU stay. Donor age was similar in both groups, but donor weight and BMI were slightly higher in the LL group, which also included a higher percentage of

Discussion

LDLT is an excellent option for patients with end-stage liver disease in situations of donor shortage. The indications for LDLT have successfully been extended from pediatric to adult cases in the last decade. During this period, the graft type has been shifted from LL to RL. Preference for RL grafting is mainly because of its advantage in graft size, and perhaps partly because of the technical ease of right hepatectomy. In LDLT, success for the recipient is important for sure, but the most

References (8)

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    Non-directed A-LLD were given the option to donate to either a child or an adult. We recommended donating the left lateral segment (LLS) as the first option because of the lower risks compared with donation of a full left or right lobe graft (RL),11,19–22 but respected the donor’s autonomy to make an informed decision to donate to an adult if that was their preference. Differences in risks between the different donor procedures were explained in detail to the potential donors in order for them to be able to take an informed decision.

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This work was supported by grants from Health and welfare surcharge of tobacco products, Ministry of Health and Welfare, Taiwan (MOHW103-TD-B-111-07, MOHW104-TDU-B-212-124-004, MOHW105-TDU-B-212-134006 to Chen CL). and Chang Gung Medical Foundation Institutional Review Board, Taiwan approval has been obtained (104-8523B and 101-3673B).

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