Use of a Right Lateral Sector Graft in Living Donor Liver Transplantation Is Feasible, but Special Caution Is Needed With Respect to Liver Anatomy

Abstract

Right lateral sector (RLS) grafting has been introduced to enlarge the potential donor pool for living donor liver transplantation (LDLT); however, evidence of its feasibility is limited. Data from 437 LDLTs carried out between 2000 and 2013 were analyzed retrospectively. LDLTs using a right liver graft (n = 251) were compared with those using a RLS graft (RLSG; n = 28). No donor mortality occurred, and the major complication rates were similar between the two groups. Postoperative liver function preservation was better in the RLSG donors. Concerning the recipients, the mortality and overall survival rates were similar between the two groups. The complication rate for the recipients was higher when more than two arterial or biliary anastomoses were necessary. A systematic literature search identified four reports on LDLT using RLSGs. Among 66 LDLTs, including the present series, there were no cases of donor death, and the rates of major and minor complications in the donors were 6% and 29%, respectively. The major complication and overall mortality rates in the recipients were 29% and 6%, respectively. LDLT using an RLSG is feasible, with an acceptable survival rate among the recipients.Abbreviations: A6, A7, and A8, hepatic arteries flowing into segments 6, 7, and 8, respectively; ALT, serum alanine aminotransferase; AST, serum aspartate aminotransferase; HAT, hepatic artery thrombosis; INR, international normalized ratio; IQR, interquartile range; LDLT, living donor liver transplantation; LLG, left liver graft; MELD, model for endstage liver disease; n.a., not available; RAHA, right anterior hepatic artery; RHA, right hepatic artery; RLG, right liver graft; RL, right liver; RLSG, right lateral sector graft; RLS, right lateral sector; RPHA, right posterior hepatic artery; RPPV, right posterior portal vein; SLV, standard liver volume

Clinical Anatomy of the Liver: Review of the 19th Meeting of the Japanese Research Society of Clinical Anatomy

“…No ischemic complications occurred in these donors ( fig. 17 B2) [24] . The accessory hepatic artery was preserved, while A6 and A7 were reconstructed individually.…”

Liver transplantation in Japan

“…At present, the number of LDLTs with right lobe grafts and left lobe grafts with or without the caudate lobe are approximately the same. In adult‐to‐adult LDLT, the right posterior segment is a useful option . The number of each graft type is shown in Table .…”

Living donor liver transplantation using an extended right lateral sector graft

“…LDLT using an RLS graft is therefore feasible, with an acceptable survival rate in recipients. (2) The preoperative evaluation of the vascular anatomy and liver sector of the donor using a 3D analysis was useful in the graft decision in the present study, although 3D analyses had only been used to evaluate the volume and congestion area of the liver previously. The RPMS was initially divided into segments V and VIII by Couinaud.…”

“…Indeed, the RLS graft is useful as an alternative graft with respect to the donor's safety. (2) However, the RLS graft obtained from a living donor often does not satisfy the recipient's metabolic demand. To resolve this issue and satisfy the recipient's metabolic demand, we performed LDLT using an extended RLS graft, which includes a RPMS-dorsal.…”