RIGHT LOBE GRAFT IN LIVING DONOR LIVER TRANSPLANTATION

Abstract

23 Limitation of donor selection due to the small-for-size problem has been the biggest barrier to expand the indication of living donor liver transplantation to adult patients. To overcome this problem, right lobe grafting has been used since last year. The aim of this preliminary evaluation was to assess the feasibility of this new program. Since February 1998, a total of 26 recipients has undergone living donor liver transplantation using a right lobe graft. The recipients' age ranged from 14 to 54 (mean:34), and their body weight ranged from 40 to 77 kg (mean:55kg). The age of the donors ranged from 21 to 57 (mean: 44). The donor was one of the parents in 12 cases (six mothers and six fathers), one of the siblings in nine (seven brothers and two sisters), a daughter in two, and a husband in three. The graft was a right lobe which did not include the middle hepatic vein of the donor. When the graft had a major right inferior hepatic vein, it was additionally anastomosed to the caval wall. The graft weight/recipient body weight ratio was more than 0.8% in all but two cases. In one case with a ratio of 0.68%, the right lobe was transplanted as orthotopic auxiliary graft. Average blood loss (337+/−175g) during the donor operation was comparable to that for left lobe grafting. Postoperative hospital stay of the donor was 7 to 14 days except for two recipients, who needed longer because of bile leakage. No donors showed any persistent serious complications. All the donors recovered from moderate post-transplant hyperbilirubinemia. Twenty recipients (76.9%) were successfully treated with this procedure. Surgical complications of recipients included intraperitoneal bleeding in five cases, bile leakage in four, intestinal perforation in three, and possible outflow block in a graft with three draining hepatic veins in one case. The cause of death of six recipients included three cases with multiorgan failure related to poor pre-transplant conditions, one congestive liver failure due to possible outflow block, one cerebral infarction, and one acute graft failure which occurred 4 months after the transplant and with unknown cause. We conclude that right lobe grafting is a safe and effective procedure for expanding the indication of living donor liver transplantation to adult recipients.