Adult-to-adult living donor liver transplantation using right lobe graft: report of 24 cases

Abstract

To investigate the safety and feasibility of adult-to-adult living donor liver transplantation (A-A LDLT) using right lobe graft. From January 2005 to December 2005, 24 patients, 22 males and 2 females, aged 20 - 53, with the underlying diseases of liver cirrhosis, hepatocellular carcinoma, and Budd-Chiari syndrome, underwent A-A LDLT using right lobe graft. During the second period, including 22 cases, modified techniques were adopted, e.g. direct anastomosis of the right hepatic vein (RHV) and inferior vena cava was performed in all 22 cases, reconstruction of inferior right hepatic vein was performed on 9 cases, and reconstruction of tributaries of middle hepatic vein by interposing a vein graft on 10 cases so as to provide sufficient venous outflow. No sever complication and death was found in the donors. The graft and recipient weight ratio was 0.72% - 1.17%, being < 1.0% among 19 cases and being < 0.8% among 4 cases. During the first period one of the 2 patients suffered from stenosis at the anastomotic stoma of the right hepatic vein, and the other patient suffered from small-for-size syndrome and died. During the second period modified techniques were adopted and no more small-for-size syndrome occurred. With the modified techniques, A-A LDLT has become a relative safe procedure.