Right Living Donor Liver Transplantation: An Option for Adult Patients

Malagó, Massimo; Testa, Giuliano; Frilling, Andrea; Nadalin, Silvio; Valentin‐Gamazo, Camino; Paul, Andreas; Lang, Hauke; Treichel, Ulrich; Cicinnati, Vito R.; Gerken, Guido; Broelsch, Christoph E.

doi:10.1097/01.sla.0000098619.71694.74

Cited by 176 publications

(160 citation statements)

References 33 publications

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“…Inclusion of the MHV with right grafts, which has been reported to optimize graft function [1,4,7,25] but to potentially impair remnant recovery [1,[26][27][28] , has both …”

Section: Discussionmentioning

confidence: 99%

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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“…Inclusion of the MHV with right grafts, which has been reported to optimize graft function [1,4,7,25] but to potentially impair remnant recovery [1,[26][27][28] , has both …”

Section: Discussionmentioning

confidence: 99%

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 rapid growth of ALDLT is attributable to the refractory shortage of deceased donor liver grafts and the ever-improving recipient survivals. [2][3][4] Studies have already proved that ALDLT reduces the mortality of recipients listed for deceased donor liver transplantation. 5,6 Concerns about ALDLT stem from the magnitude of the donor procedure.…”

mentioning

confidence: 99%

Donor quality of life before and after adult-to-adult right liver live donor liver transplantation

Chan

Liu

et al. 2006

Liver Transpl

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Donor right hepatectomy for adult-to-adult live donor liver transplantation (ALDLT) is a major surgical operation for the benefit of the recipient. Justification of procedure mandates knowledge of the possible physical and psychological negative effects on the donor. We prospectively and longitudinally quantified donor quality of life using generic and condition-specific questionnaires up to 1 year. The generic questionnaires were the Karnofsky Performance Status scale and the Chinese (Hong Kong) version of the Medical Outcomes Study 36-Item Short-Form Survey, which measures 8 health concepts: 4 physical components and 4 mental components. Within 1 year, 30 consecutive donors were included. These 11 male and 19 female donors (36.7% and 63.3%, respectively) had a median age of 35 years (range, 21-56 years). There was no donor mortality or major complications. Donor quality-of-life worsening was most significant in the first 3 postoperative months, particularly among the physical components. The physical and mental components returned to the previous levels in 6 to 12 months' time, though the Karnofsky performance scores were slightly lower at 1 year (P ϭ 0.011). Twenty-six (86.7%) donors declared that they would donate again if there were such a need and it were technically possible. It was noticed that older donors were more likely to express unwillingness to donate again. In conclusion, the temporary worsening of donor quality of life substantiates ALDLT as an acceptable treatment modality. Liver Transpl 12: 1529-1536, 2006.

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“…Hence, there is an increased chance for multiple bile duct ostia being present in the right lobe after the split is completed. 8 Here, what is more important is to cut the bile duct on a correct plane when being transected. A transection on an incorrect plane not only increases the number of bile ducts to be anastomosed but increases ischemia risk and the associated risk of anastomosis leak by causing the posteromedial wall of the right posterior bile canal to be skeletonized.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Complications, including those involving bile ducts, are more frequent in living donor transplant procedures using partial grafts than in transplants with deceased donations. [6][7][8] The reported risk factors for biliary complications after anastomosis are rather confusing. Although biliary anatomic variations in donors and surgical techniques are widely acknowledged risk factors for recipient biliary complications, 9,10 it has been reported that donor age, donor body mass index, and macrovacuolar steatosis of the graft may be independent risk factors for biliary complications.…”

Section: Introductionmentioning

confidence: 99%

Effect of Right Posterior Bile Duct Anatomy on Biliary Complications in Patients Undergoing Right Lobe Living Donor Liver Transplant

Tezcaner¹,

Dinc²,

Karakayalı³

et al. 2019

Exp Clin Transplant

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Objectives: Our aim was to evaluate the influence of the localization of right posterior bile duct anatomy relative to portal vein of the donors on posttransplant bile duct complications. Materials and Methods: We retrospectively investigated 141 patients who had undergone living donor liver transplant using right hemiliver grafts. The patients were classified based on the pattern of the right posterior bile duct and divided into infraportal and supraportal types. Clinical donor and recipient risk factors and surgical outcomes were compared for their relationship with biliary complications using logistic regression analyses. Results: The 2 groups were similar according to demographic and clinical features. The biliary complication rate was 23.7% (9/38) in the infraportal group and 47.4% (37/78) in the supraportal group (P = .014). An analysis of risk factors for the development of anastomotic bile leak using logistic regression showed that a supraportal right posterior bile duct anatomy was a statistically significant positive predictor, with odds ratio of 18.905 (P = .012; confidence interval, 1.922-185.967). The distance of the right posterior bile duct from confluence was significantly lower in patients with biliary complications than in those without (mean of 7.66 vs 0.40 mm; P = .044). According to receiver operating characteristic analyses, the cutoff point for the length of right bile duct to right posterior bile duct from the hepatic confluence was 9.5 mm regarding presence of complications. Conclusions: Factors influencing bile duct anastomosis leakage were supraportal-type donor bile duct anatomy and length of the right main bile duct from biliary confluence. Hepatic arterial complications were similarly a risk factor for biliary strictures. Because of the multiple factors leading to complications in living donor liver transplant, it is challenging to group these patients by operative risk; however, establishing risk models may facilitate the prediction of complications.

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Right Living Donor Liver Transplantation: An Option for Adult Patients

Cited by 176 publications

References 33 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

Donor quality of life before and after adult-to-adult right liver live donor liver transplantation

Effect of Right Posterior Bile Duct Anatomy on Biliary Complications in Patients Undergoing Right Lobe Living Donor Liver Transplant

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