Donor Outcomes After Liver Donation in Adult to Adult Living Donor Liver Transplantation

Hsu, Hsien‐Wen; Tsang, Leo Leung-Chit; Ou, Hsin‐You; Huang, Tung‐Liang; Chen, T.-Y.; Yu, Chun Yen; Lim, Wei-Xiong; Tong, Yu-Shun; Chen, C.-L.; Cheng, Yu‐Fan

doi:10.1016/j.transproceed.2018.04.006

Cited by 7 publications

(9 citation statements)

References 15 publications

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“…Hsu et al reported that when the future of remnant liver volume was less than 35% there was higher rate of complications. Also post operative AST, ALT, bilirubin, length of intensive care and stay and length of overall hospital stay was higher [11]. In our series among the donors with any complication, only 1 donor had less than 35% future remnant liver, all others had greater than 35% FLR.…”

Section: Discussionmentioning

confidence: 43%

Canlı Vericili Karaciğer Naklinde Retrospektif Donör Hepatektomi Sonuçları- Tek Merkez Deneyimi

Donmez

Andaçoğlu

2021

Archives of Clinical and Experimental Medicine

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Objectives: We aimed to describe our technique and donor selection for donor hepatectomy, review our case series and report our complication rates and outcomes. Materials and Methods: We retrospectively reviewed 41 consecutive donor hepatectomy cases between October 2019 and November 2020 at Yeditepe University, Istanbul, Turkey. Complications were graded according to Clavien-Dindo classification. All cases were performed via laparotomy. Results: Out of 41 donor cases, 38 (92.6%) were right lobe, 2 (4.8%) were left lobe and 1 (2.4%) was left lateral segment donor hepatectomy. Follow up was 9 ±2,2 months (4-16 months). There were 8 (19.5%) complications and all were minor (grade 1 or 2). There were no grade 3 or higher complications. Three (7.3%) of our donors are heterozygous for Factor Leiden mutation and 4 (9.7%) of our donors had heterozygous prothrombin mutation. Length of stay was average 6.4±1.4 days (range=5-12). Ten donors lost weight with a supervised diet and exercise program. There was one wound complication in this subset of patients. Conclusions: We present our single center donor hepatectomy series with excellent results. We also describe successful weight loss for donors with Body Mass Index >30 kg/m 2 . Donor safety is the most important component of living donor liver transplantation. As donor results continue to improve, living donor liver transplant will continue expand worldwide.

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Section: Discussionmentioning

confidence: 43%

Canlı Vericili Karaciğer Naklinde Retrospektif Donör Hepatektomi Sonuçları- Tek Merkez Deneyimi

Donmez

Andaçoğlu

2021

Archives of Clinical and Experimental Medicine

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“…[17,18] Also, the residual liver volume was adequate to ensure the safety of the donor. [15] As reported by Leelaudomlipi et al, [19] the right anterior segment has an average volume ratio of 37%, whereas volumes of the left lateral section, left medial section, caudate lobe, and right posterior section were 17%, 14%, 2%, and 30%, respectively. Thus, the right anterior section could be a promising alternative option in selected patients with a disproportionate distribution of liver mass.…”

Section: Discussionmentioning

confidence: 75%

“…The right lobe graft had a GWRW of 1.21%, but had a residual volume of 23.81% that could significantly increase the risk of hepatic insufficiency postoperatively of the donor. [13–15] Moreover, the right posterior graft and the left lobe graft had a GWRW of <0.8% which could otherwise increase the risk of SFSS after liver transplantation. [16]…”

Section: Discussionmentioning

confidence: 99%

Right anterior section graft for living-donor liver transplantation

Navarro

Choi²,

Kim³

et al. 2019

Medicine

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Rationale: In living-donor liver transplantation (LDLT), the right lobe graft is commonly utilized to prevent small-for-size syndrome, despite the considerable donor morbidity. Conversely, the feasibility of the left lobe graft and the right posterior section graft in smaller-sized recipients is now commonly employed with comparable outcomes to right lobe grafts. The efficacy of the right anterior section graft has rarely been reported. Patient concerns: A 56-year-old man, a heavy alcoholic beverage drinker for 20 years, presented in the emergency department with massive ascites and lethargy. He was previously admitted twice due to bleeding esophageal varices. Diagnosis: He was diagnosed with hepatic encephalopathy coma due to alcoholic liver cirrhosis. The Child–Turcotte–Pugh score was 11 (class C), and the Model for End-stage Liver Disease score was 21.62. Intervention: A LDTL was offered to the patient as the best treatment option available. The patient's 26-year-old son was found to be the only donor-compatible candidate for the LDTL. Preoperatively, the right lobe of the donor occupied 76.2% of the total liver volume exposing the donor to a small residual liver volume. The right posterior section and left lobe volumes were insufficient, providing a graft-to-recipient weight ratio of 0.42% and 0.38%, respectively. However, the right anterior section could fulfill an acceptable GRWR of 0.83%. Thus, a living donor right anterior sectionectomy was performed. Outcomes: Clinical signs and symptoms and liver function improved following anterior section graft transplantation without complications. Lesson: The procurement of anterior section graft is technically feasible in selected patients, especially in high-volume liver centers.

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“…Sixty-seven unique studies, including 3 conference abstracts, met our inclusion criteria. 6-8,21-75 Fifty-three articles compared surgical outcomes between RL and LL donors and 31 between RL- and LL-LDLT recipients. Included studies were conducted mostly in Asia (n = 52, 77.6%), with few reports from Europe (n = 9, 13.4%) and the Americas (n = 5, 7.5%).…”

Section: Resultsmentioning

confidence: 99%

“…22,23,26-32,37,39-41,44-46,49,59,63,65,66,73,74 All remaining 4 studies had scores between 5 and 7 and were classified as of moderate quality. 6-8,24,25,33-35,38,42,43,47,48,50,51,53-58,60-62,64,67-72,75 Publication bias was evaluated for 6 meta-analyses including ≥10 studies ( Figure S1, SDC , http://links.lww.com/TP/C459). Asymmetry was only identified for the donor bile leak meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

Right Lobe Versus Left Lobe Living Donor Liver Transplantation: A Systematic Review and Meta-analysis of Donor and Recipient Outcomes

et al. 2022

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Background. Living donor liver transplantation (LDLT) is an established treatment for advanced liver disease. Whether right lobe (RL) or left lobe (LL) LDLT provides the best outcomes for donors and recipients remains contentious. Methods. MedLine, Embase, PubMed, and Cochrane Central were searched to identify studies comparing RL- and LL-LDLT and reporting donor and/or recipient outcomes. Effect sizes were pooled using random-effect meta-analysis. Meta-regressions were used to explore heterogeneity. Results. Sixty-seven studies were included. RL donors were more likely to experience major complications (relative risk [RR] = 1.63; 95% confidence interval [CI] = 1.30-2.05; I 2 = 19%) than LL donors; however, no difference was observed in the risk of any biliary complication (RR = 1.41; 95% CI = 0.91-2.20; I 2 = 59%), bile leaks (RR = 1.56; 95% CI = 0.97-2.51; I 2 = 52%), biliary strictures (RR = 0.99; 95% CI = 0.43-1.88; I 2 = 27%), or postoperative death (RR = 0.51; 95% CI = 0.25-1.05; I 2 = 0%). Among recipients, the incidence of major complications (RR = 0.85; 95% CI = 0.68-1.06; I 2 = 21%), biliary complications (RR = 1.10; 95% CI = 0.91-1.33; I 2 = 8%), and vascular complications (RR = 0.79; 95% CI = 0.44-1.43; I 2 = 0%) was similar. Although the rate of small for size syndrome (RR = 0.47; 95% CI = 0.30-0.74; I 2 = 0%) and postoperative deaths (RR = 0.62; 95% CI = 0.44-0.87; I 2 = 0%) was lower among RL-LDLT recipients, no differences were observed in long-term graft (hazard ratio = 0.87; 95% CI = 0.55-1.38; I 2 = 74%) and overall survival (hazard ratio = 0.86; 95% CI = 0.60-1.22; I 2 = 44%). Conclusions. LL donors experience fewer complications than RL donors, and LL-LDLT recipients had similar outcomes to RL-LDLT recipients. These findings suggest that LL-LDLT offers the best outcomes for living donors and similar outcomes for recipients when measures are taken to prevent small for size syndrome.

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Donor Outcomes After Liver Donation in Adult to Adult Living Donor Liver Transplantation

Cited by 7 publications

References 15 publications

Canlı Vericili Karaciğer Naklinde Retrospektif Donör Hepatektomi Sonuçları- Tek Merkez Deneyimi

Canlı Vericili Karaciğer Naklinde Retrospektif Donör Hepatektomi Sonuçları- Tek Merkez Deneyimi

Right anterior section graft for living-donor liver transplantation

Right Lobe Versus Left Lobe Living Donor Liver Transplantation: A Systematic Review and Meta-analysis of Donor and Recipient Outcomes

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