Left Versus Right Liver Graft in Adult-to-Adult Living Donor Liver Transplantation: Comparable Outcome with an Optimal Approach to Overcome the Small-for-Size Syndrome

Abstract

Introduction: Adult-to-adult living donor liver transplantation has been a dominant type of liver transplantation, especially in Asian countries where deceased donors are scarce. Many centers still prefer to choose the right liver graft (RLG) compared to the left liver graft (LLG) for better recovery of recipients. This study compared clinical outcomes of donors and recipients between the LLG and RLG. Method: The study cohort comprised of 25 (21.2%) patients in the LLG group and 93 (78.8%) in the RLG group. When both portal flow (≥300 ml/min/100gLW) and hepatic venous pressure gradient (≥10 mmHg) were increased, splenic artery ligation was performed for portal modulation. After the operation, somatostatin was administered when small-for-size syndrome (SFSS) was highly suspected. Results: In donor outcomes, graft-to-recipient weight ratio was lower in the LLG group than in the RLG group (median 0.93 [0.64–1.50] vs. 1.03 [1.00–1.66], P<0.001). Total bilirubin on POD 5 were lower in the LLG group than the RLG group (0.96 [0.50–2.47] vs. 1.50 [0.45–4.14], P=0.005). In recipient outcomes, SFSS frequently occurred in the LLG group compared to the RLG group (4 [16%] vs. 3 [3.2%], P=0.036). For portal modulation, 17 patients underwent splenic artery ligation, and 5 received intravenous continuous somatostatin after the operation. There was no significant difference in short-term surgical morbidity and mortality and long-term outcomes between the groups. Conclusion: This study demonstrates comparable outcomes between the LLG and RLG groups. With an optimal portal modulation strategy to overcome SFSS, LLG is safe and feasible to consider.