Long-Term Follow-Up After Right Hepatectomy for Adult Living Donation and Attitudes Toward the Procedure

Sotiropoulos, Georgios C.; Radtke, Arnold; Molmenti, Ernesto P.; Schroeder, Tobias; Baba, Hideo A.; Frilling, Andrea; Broelsch, Christoph E.; Malagó, Massimo

doi:10.1097/sla.0b013e31823594ae

Cited by 41 publications

(62 citation statements)

References 42 publications

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“…The subgroup analysis of the Istambul series [7] revealed a much higher overall complication rate in non-MHV (22.4%) vs MHV-contained remnants (7.8%) mirroring our own experience with the tendency for (-) MHV remnants to have more complications than (+) MHV ones (25% vs14%). Furthermore, our experience as well as that of others did not reveal any late complications attributable to remnant size or MHV-status [7,35] . Our virtual data however, showed that the "sacrifice" of the left sided MHV-4A/B drainage in remnants due to MHV inclusion with the graft was associated with large congestive volumes (CV-index of 36.9 ± 11.6 %RV) that resulted in a significant reduction of non-congestive volumes (non-congestive-RVBWR) safely drained by LHV.…”

Section: Table 4 Middle Hepatic Vein Management In Small-for-size -Rementioning

confidence: 71%

Risk of venous congestion in live donors of extended right liver graft

Radtke¹,

Sgourakis²,

Molmenti³

et al. 2015

WJG

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AIM:To investigate middle hepatic vein (MHV) management in adult living donor liver transplantation and safer remnant volumes (RV). METHODS:There were 59 grafts with and 12 grafts without MHV (including 4 with MHV-5/8 reconstructions). All donors underwent our five-step protocol evaluation containing a preoperative protocol liver biopsy Congestive vs non-congestive RV, remnantvolume-body-weight ratios (RVBWR) and postoperative outcomes were evaluated in 71 right graft living donors. Dominant vs non-dominant MHV anatomy in total liver volume (d-MHV/TLV vs nd-MHV/TLV) was constellated with large/small congestion volumes (CVindex). Small for size (SFS) and non-SFS remnant considerations were based on standard cut-off-RVBWR and RV/TLV. Non-congestive RVBWR was based on non-congestive RV. RESULTS:MHV and non-MHV remnants showed no significant differences in RV, RV/TLV, RVBWR, total bilirubin, or INR. SFS-remnants with RV/TLV < 30% and non-SFS-remnants with RV/TLV ≥ 30% showed Prospective Study Risk of venous congestion in live donors of extended right liver graftArnold Radtke, George Sgourakis, Ernesto P Molmenti, Susanne Beckebaum, Vito R Cicinnati, Hartmut Schmidt,Christoph E Broelsch, Massimo Malagó, Tobias Schroeder Radtke A et al . Liver failure in live donors of right grafts 6009May 21, 2015|Volume 21|Issue 19| WJG|www.wjgnet.com no significant differences either. RV and RVBWR for non-MHV (n = 59) and MHV-containing (n = 12) remnants were 550 ± 95 mL and 0.79 ± 0.1 mL vs 568 ± 97 mL and 0.79 ± 0.13, respectively (P = 0.423 and P = 0.919. Mean left RV/TLV was 35.8% ± 3.9%.Non-MHV (n = 59) and MHV-containing (n = 12) remnants (34.1% ± 3% vs 36% ± 4% respectively, P = 0.148. Eight SFS-remnants with RVBWR < 0.65 had a significantly smaller RV/TLV than 63 non-SFSremnants with RVBWR ≥ 0.65 [SFS: RV/TLV 32.4%(range: 28%-35.7%) vs non-SFS: RV/TLV 36.2% (range: 26.1%-45.5%), P < 0.009. Six SFS-remnants with RV/TLV < 30% had significantly smaller RVBWR than 65 non-SFS-remnants with RV/TLV ≥ 30% (0.65 (range: 0.6-0.7) vs 0.8 (range: 0.6-1.27), P < 0.01. Two (2.8%) donors developed reversible liver failure. RVBWR and RV/TLV were concordant in 25%-33% of SFS and in 92%-94% of non-SFS remnants. MHV management options including complete MHV vs MHV-4A selective retention were necessary in n = 12 vs n = 2 remnants based on particularly risky congestive and non-congestive volume constellations. CONCLUSION:MHV procurement should consider individual remnant congestive-and non-congestive volume components and anatomy characteristics, RVBWR-RV/TLV constellation enables the identification of marginally small remnants.

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Section: Table 4 Middle Hepatic Vein Management In Small-for-size -Rementioning

confidence: 71%

Risk of venous congestion in live donors of extended right liver graft

Radtke¹,

Sgourakis²,

Molmenti³

et al. 2015

WJG

Self Cite

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“…The duration of the follow-up has also been controversial. 18 It is obvious that limiting the observation to the hospital stay is insufficient due to major center variations, and a consensus seems to arise proposing a minimum of 3 months. [19][20][21][22][23][24][25][26][27] In the current study, a number of events occurred between the time of discharge and 3 months postoperatively, but very few afterward corroborating the standardized use of benchmarking at 3 months.…”

Section: Discussionmentioning

confidence: 99%

Defining Benchmarks for Major Liver Surgery

Rössler¹,

et al. 2016

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“…Further, the partial liver's ability to regenerate both as a graft (in the recipient) and remnant (in the donor), probably is the main justification for the safety of right lobe living donor liver transplantation (RLLDLT). A review of previous studies showed that full recovery of the liver donor occurs soon after right lobe donation (1); yet, other studies that addressed the ethical and psychological aspects in living donation showed that even several months after RL donation, donors do not show full recovery to their preoperative status with respect to social, work, and health parameters (2,3). The same questions could thus be posed regarding the ad integrum recovery (recovery to predonation status) of the donors' liver function and volume.…”

Section: Recovery Of Normal Liver Function (Prothrombin Time [Pt]mentioning

confidence: 99%

Ad Integrum Functional and Volumetric Recovery in Right Lobe Living Donors: Is It Really Complete 1 Year After Donor Hepatectomy?

Duclos

Bhangui

Salloum

et al. 2016

American Journal of Transplantation

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Julie Duclos and Prashant Bhangui are co-first authors.The partial liver's ability to regenerate both as a graft and remnant justifies right lobe (RL) living donor liver transplantation. We studied (using biochemical and radiological parameters) the rate, extent of, and predictors of functional and volumetric recovery of the remnant left liver (RLL) during the first year in 91 consecutive RL donors. Recovery of normal liver function (prothrombin time [PT] !70% of normal and total bilirubin [TB] 20 mmol/L), liver volumetric recovery, and percentage RLL growth were analyzed. Normal liver function was regained by postoperative day's 7, 30, and 365 in 52%, 86%, and 96% donors, respectively. Similarly, mean liver volumetric recovery was 64%, 71%, and 85%; whereas the percentage liver growth was 85%, 105%, and 146%, respectively. Preoperative PT value (p ¼ 0.01), RLL/total liver volume (TLV) ratio (p ¼ 0.03), middle hepatic vein harvesting (p ¼ 0.02), and postoperative peak TB (p < 0.01) were predictors of early functional recovery, whereas donor age (p ¼ 0.03), RLL/ TLV ratio (p ¼ 0.004), and TLV/ body weight ratio (p ¼ 0.02) predicted early volumetric recuperation. One-year post-RL donor hepatectomy, though functional recovery occurs in almost all (96%), donors had incomplete restoration (85%) of preoperative total liver volume. Modifiable predictors of regeneration could help in better and safer donor selection, while continuing to ensure successful recipient outcomes.Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; BSA, body surface area; CT, computed tomography scan; GGT, gamma glutamyl transpeptidase; ICG RT15 , indocyanine green retention rate at 15 min; ISGLS, International Study Group of Liver Surgery; MHV, middle hepatic vein; PHLF, posthepatectomy liver failure; POD, postoperative day; PT, prothrombin time; RL, right lobe; RLL, remnant left liver; RLLDLT, right lobe living donor liver transplantation; RLL/BW, remnant left liver to body weight ratio; RLL/TLV, remnant left liver to total liver volume ratio; SLV, standard liver volume; TB, serum total bilirubin; TLV, total liver volume

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Long-Term Follow-Up After Right Hepatectomy for Adult Living Donation and Attitudes Toward the Procedure

Abstract: ALDLT donors are at risk for long-term complaints that are neither reflected nor related to early complications. This information should be included in both the donor evaluation and the ALDLT decision-making process.

Cited by 41 publications

References 42 publications

Risk of venous congestion in live donors of extended right liver graft

Risk of venous congestion in live donors of extended right liver graft

Defining Benchmarks for Major Liver Surgery

Ad Integrum Functional and Volumetric Recovery in Right Lobe Living Donors: Is It Really Complete 1 Year After Donor Hepatectomy?

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