Selection and outcomes of living donors with a remnant volume less than 30% after right hepatectomy

Abstract

The evidence for defining a safe minimal remnant volume after living donor hepatectomy is insufficient. The aim of this study was to evaluate the outcomes of living donors with a remnant/total volume ratio (RTVR) < 30% after right hepatectomy according to the following selection criteria: the preservation of the middle hepatic vein (MHV), an age < 50 years, and no or mild fatty changes in healthy adults. All living donors who underwent right hepatectomy preserving the MHV at our institution between January 2005 and September 2011 were divided into 2 groups: group A with an RTVR < 30% and group B with an RTVR 30%. Perioperative data, complications by the Clavien classification, and outcomes with at least 15.1 months' follow-up were compared. Twenty-eight donors were enrolled in group A, and 260 were enrolled in group B. The estimated liver volume was strongly correlated with the actual graft weight (R 2 5 0.608, P < 0.001). The calculated donation liver volume and the RTVR were significantly different between the 2 groups (P 5 0.03 and P < 0.001, respectively). The peak postoperative aspartate aminotransferase levels, alanine aminotransferase levels, and international normalized ratios did not differ between the 2 groups. The peak total bilirubin level was higher for group A versus group B (P 5 0.04). The hospital stay was longer for group A versus group B (P < 0.001). All donors recovered completely, and there were no significant differences in overall complications between the 2 groups. In conclusion, right hepatectomy preserving the MHV with an RTVR < 30% can be safely indicated for carefully selected living donors less than 50 years old with no or mild fatty changes.

Successful Living Donor Liver Transplantation Between Septuagenarians

“…The donor selection criteria and evaluation have been described elsewhere (3,13,14). At the very beginning of our LDLT program in January 2005, the upper age limit was 59 years, and then, after overcoming the learning curve (13), elderly donors aged !60 have been carefully accepted since March 2008 by the selection criteria: preservation of middle hepatic vein, a remnant liver volume !30% and no or mild fatty change in healthy condition.…”

The Impact of a Surgical Protocol for Enhanced Recovery on Living Donor Right Hepatectomy

“…In the meantime, the selection criteria for LDRH have been extended with advanced surgical technique and improved management without compromising donor safety. 2,8–10 …”

“…However, if healthy donors were less than 50 years old with no or mild fatty liver, a remnant left liver volume <30% of total liver volume was selected carefully, in which case the middle hepatic vein (MHV) was absolutely preserved in donors. 8 …”

Proposal of new expanded selection criteria using total tumor size and18F-fluorodeoxyglucose - positron emission tomography/computed tomography for living donor liver transplantation in patients with hepatocellular carcinoma: The National Cancer Center Korea criteria

“…We do not recommend the downstaging or bridging therapy before LDLT even though the patient had advanced HCC. The operative techniques, immunosuppression, and management for hepatitis virus of donor and recipient have been described in detail in previous our reports [16,17] . Patients were followed up periodically with interval 3 or 6 mo using imaging studies such as ultrasonography, abdomen, and chest MDCT with AFP and DCP level.…”