Living related right lobe liver transplantation at Ankara University

Abstract

HE unique surgical anatomy of the liver allows it to be separated into independent anatomic units that can be transplanted. With the recent surgical innovations, livingrelated right lobe liver transplantation (LDRLT) is becaming the main source of organ supply for adult recipients in countries with a shortage of cadaver donors. PATIENTS At Ankara University Medical School, we performed 5 LDRLT in the last 16 months. Two of the donors were mothers, 2 were sisters, and 1 was a cousin. The donors were 44, 45, 46, 36, and 23 years old. The volumes of the right lobe grafts were 810, 860, 980, 650, and 1,000 mL. Four grafts had 2 bile ducts while the third one had 3. All grafts had single right hepatic vein and right hepatic artery, while 1 graft had separate anterior and posterior portal branches that required a cadaveric iliac vein graft for reconstruction. One donor received only autologous blood transfusion, while the last case was performed without any transfusion. The average donor heterologus blood transfusion was 1,150 mL for the other 3 donors. One donor experienced a transfusion reaction, with serious intravascular hemolysis that required plasma exchange. None of the donors experienced a surgical complication. The recipient ages were 22, 23, 35, 36, and 27 years. Etiology for recipient cirrhosis were Wilson’s disease, autoimmune hepatitis, and hepatitis B (3 cases). After recipient hepatectomy with preservation of the vena cava, hepatic veins were oversewn and right hepatic veins were anastomosed directly to a separate incision on the vena cava. No accessory hepatic veins or posterior hepatic vein anastomoses were done. Hepatic artery anastomoses were done under 2.5 loop magnification. One patient required an infrarenal aorto-hepatic artery saphenous vein interposition graft. In 4 patients, temporary end-to-side portocaval anastomoses were constructed for portal decompression using the right branch of the portal vein. Bile ducts were anastomosed to a Roux-Y limb over an external stent.