Right Lobes Research Articles

Effect of donor warm ischemia time during graft extraction in right lobe robotic donor hepatectomy on recipient outcomes—A propensity score matched analysis

One of the concerns specific to minimally invasive donor hepatectomy (MIDH) is the prolonged time required for graft extraction after completion of the donor hepatectomy (donor warm ischemia time [DWIT]). There has never been an objective evaluation of minimally invasive donor hepatectomy-DWIT on allograft function in living donor liver transplantation. We evaluated the effect of DWIT following robotic donor hepatectomy (RDH) on recipient outcomes and compared them with a matched cohort of open donor hepatectomy (ODH). Demographic, perioperative, and recipient’s postoperative outcome data for all right lobe (RL)-RDH performed between September 2019 and July 2023 were analyzed and compared with a propensity score matched cohort (1:1) of RL-ODH from the same time period. Of a total of 103 RL-RDH and 446 RL-ODH, unmatched and propensity score matched analysis (1:1) revealed a significantly longer DWIT in the RDH group as compared to the ODH group (9.33 ± 3.95 vs 2.87 ± 2.13, P < .0001). This did not translate into any difference in the rates of early allograft dysfunction (EAD), biliary complications, major morbidity, or overall 1-and 3-month survival. The receiver operating characteristic curve analysis threshold for DWIT-early allograft dysfunction was 9 minutes (area under receiver operating characteristic: 0.67, sensitivity = 80%, specificity = 53.8%). We show that prolonged DWIT within an acceptable range in RDH does not have deleterious effects on short-term recipient outcomes. Further long-term studies are required to confirm our findings, especially with regard to nonanastomotic biliary complications.

Morphological Study of Variations of the Human Cadaveric Liver and Its Clinical Implications.

Introduction With increasing dependence on laparoscopic procedures, precise knowledge of external variations of the liver is essential for good surgical and interventional outcomes, preventing imaging misdiagnosis, and curtailing complications. The present study aims to evaluate the gross anatomical variations of the liver. Materials and Methods The 40 adult cadaveric livers of age 60-80 years were removed during the routine dissection for undergraduate medical students and examined for morphological variations in the form of size, shape, and fissures. Results Accessory fissures were observed on the caudate lobe (CL) in 23 (57.5%), on the quadrate lobe (QL) in seven (17.5%), on the right lobe (RL) in 29 (72.5%), and on the left lobe (LL) in 12 (30%) specimens. Netter's Type 2, Type 4, Type 5, Type 6, and Type 7 liver were observed in four (10%), seven (17.5%), one (2.5%), three (7.5%), and three (7.5%) specimens respectively. The most common shapes of the CL and QL were rectangular in 16 (40%) and quadrangular in 10 (25%) specimens respectively. Pons hepatis were seen in three (7.5%) specimens. The mean length (cm) of RL and LL were 17.75 ±3.09 and 16.9±3.69 respectively, whereas the mean transverse diameter (TD) (cm) of RL and LL were 7.98±1.20 and 7.85±1.58 respectively. The mean length and TD (cm) of CL were 5.62±1.67 and 2.48±1.00 respectively. The mean length and TD (cm) of the QL were 6.00±1.51 and 2.81±0.83 respectively. Conclusion Precise knowledge of these variations would be helpful for surgeons in planning and performing surgical proceduresand for anatomists.

Back Table Preparation of the Right Lobe Live Donor Liver Allograft: A Crucial Part of the Adult Live Donor Liver Transplant Procedure

IntroductionWe aimed to describe our procedure for vascular reconstruction and back table bench preparation for the right lobe live donor allograft. Live donor liver transplantation (LDLT) remains an important option for the expansion of the donor pool. The procedure has been widely used, and its success is dependent on a technically perfect operation with appropriate inflow and outflow of the allograft. Adequate preparation of the right lobe (RL) allograft prior to implantation remains a vital part of the procedure. MethodsOur technique of back table vascular reconstruction of the RL allograft has been performed using a hepatic vein patch venoplasty, inferior hepatic vein inclusion, portal vein reconstruction, and segment V and VIII reconstruction for all of our LDLTs. ResultsBetween March 2009 and January 2020, 321 consecutive adult LDLTs were performed and underwent back table reconstruction with the techniques described. During that time period, no patients had hepatic insufficiency. There was a single thrombosis of a superior mesenteric vein (SMV) to PV jump conduit. ConclusionsOur technique of back table reconstruction of the LDLT right lobe graft remains a crucial part of the operative procedure. Our experience with RL grafts without middle hepatic vein (MHV) and our systematic approach for inflow and outflow reconstruction has yielded excellent results with no technical outflow issues and minimal inflow complications.

Right Lobe Versus Left Lobe Living Donor Liver Transplantation: A Systematic Review and Meta-analysis of Donor and Recipient Outcomes.

Living donor liver transplantation (LDLT) is an established treatment for advanced liver disease. Whether right lobe (RL) or left lobe (LL) LDLT provides the best outcomes for donors and recipients remains contentious. MedLine, Embase, PubMed, and Cochrane Central were searched to identify studies comparing RL- and LL-LDLT and reporting donor and/or recipient outcomes. Effect sizes were pooled using random-effect meta-analysis. Meta-regressions were used to explore heterogeneity. Sixty-seven studies were included. RL donors were more likely to experience major complications (relative risk [RR] = 1.63; 95% confidence interval [CI] = 1.30-2.05; I2 = 19%) than LL donors; however, no difference was observed in the risk of any biliary complication (RR = 1.41; 95% CI = 0.91-2.20; I2 = 59%), bile leaks (RR = 1.56; 95% CI = 0.97-2.51; I2 = 52%), biliary strictures (RR = 0.99; 95% CI = 0.43-1.88; I2 = 27%), or postoperative death (RR = 0.51; 95% CI = 0.25-1.05; I2 = 0%). Among recipients, the incidence of major complications (RR = 0.85; 95% CI = 0.68-1.06; I2 = 21%), biliary complications (RR = 1.10; 95% CI = 0.91-1.33; I2 = 8%), and vascular complications (RR = 0.79; 95% CI = 0.44-1.43; I2 = 0%) was similar. Although the rate of small for size syndrome (RR = 0.47; 95% CI = 0.30-0.74; I2 = 0%) and postoperative deaths (RR = 0.62; 95% CI = 0.44-0.87; I2 = 0%) was lower among RL-LDLT recipients, no differences were observed in long-term graft (hazard ratio = 0.87; 95% CI = 0.55-1.38; I2 = 74%) and overall survival (hazard ratio = 0.86; 95% CI = 0.60-1.22; I2 = 44%). LL donors experience fewer complications than RL donors, and LL-LDLT recipients had similar outcomes to RL-LDLT recipients. These findings suggest that LL-LDLT offers the best outcomes for living donors and similar outcomes for recipients when measures are taken to prevent small for size syndrome.

Ultrasonographic shear wave elastography of the thyroid in patients with sickle cell anemia.

Although thyroid radiology has been conducted in patients with sickle cell anemia (SCA), to our knowledge, there is no report of thyroid gland assessment using ultrasonographic shear wave elastography (US-SWE). To determine values for ultrasonographic US-SWE of the thyroid in patients with SCA and correlations between thyroid elasticity and biochemical variables used to evaluate thyroid function. Prospective case-control observational study of 36 patients with SCA and 33 healthy volunteer controls. US-SWE measurements of thyroid gland parenchyma and biochemical parameters of the participants were obtained and compared, and the diagnostic accuracy of elasticity was determined. The thyroid volume was smaller in patients with SCA than that in controls (P = 0.001). Compared with the controls, the patients with SCA had significantly lower serum levels of free triiodothyronine (fT3) (P = 0.004) and thyroglobulin (Tg) (P = 0.001) and significantly higher levels of thyroid-stimulating hormone (P = 0.028). Thyroid stiffness was significantly higher in the left lobe (LL) of the patients with SCA than in the controls (P = 0.003). In the patients with SCA, we found a significant correlation between right lobe (RL) and LL stiffness and serum levels of Tg (RL [r = -0.439] and LL [r = -0.484]; P = 0.021) and fT3 (RL [r = -0.463] and LL [r = -0.386]; P = 0.012). Receiver operating characteristic (ROC) curve analysis of thyroid elasticity that represented a diagnosis of SCA found a cutoff of >7.31 kPa, a sensitivity of 52.0%, and a specificity of 72.0% for the RL (P = 0.316, area under the curve [AUC] 0.570), and a cutoff of >8.06 kPa, a sensitivity of 58.0%, and a specificity of 84.0% for the LL (P = 0.011, AUC 0.680). US-SWE can be used to follow up thyroid changes in patients with SCA.

Adaptive morphogenesis of lamb liver under Anthropobiocenosis conditions lamb liver morphogenesis

Investigated the histological features of the structure of hepar of one-day-old lambs (ODL) using a complex of morphological techniques. It was found that hepar in ODL is formed by stroma and parenchyma. The stromal elements of the organ are formed by loose lugs of hematopoietic connective tissue, which in turn forms a capsule (2.80-7.23 microns thick), as well as the septa of the lobules, which include the hepar triads and paravasal tissue of efferent blood vessels. As a result of the studies, the prevalence of the stroma in the hematopoietic foci around large afferent blood vessels, especially in the hepar hilus, was revealed. The hepar parenchyma in ODL has structural incompleteness. It is formed by hepar cells and numerous resinusoidal cells located in the subcapsular, peripheral, central zones in the lobus hepatis. Hepar cells located in the subcapsular zone (SZ) have a more optically cleared (OC) cytoplasm, and the practically cleared cytoplasm of the hepatocyte diameter (HD) decreases towards the central zone (CZ). In the hepar parenchyma of the ODL, hematopoiesis foci (HF) are established in each of the lobes, which tend to decrease from the periphery to the center of the lobes. Hemopoetic cells (HC) are located between hepatocytes, densely layering on top of each other, and there are also cells located sparsely between the liver cells (LC). The number of hepatocytes per 1 mm2 of the area of the histological specimen in the left lobe (LL) of the ODL reaches the highest value 5983.79 ± 90.40, in the right lobe (RL) of the liver it is 5358.80 ± 646.60, while in the middle it has a minimum value and reaches 5133.10 ± 205.75.

Safe use of right lobe living donor livers with moderate steatosis in adult-to-adult living donor liver transplantation: a retrospective study.

Hepatic steatosis (HS) beyond a certain degree can jeopardize living donor (LD) safety, particularly in right lobe (RL) donors, making it a major obstacle for donor pool expansion in adult-to-adult living donor liver transplantation (ALDLT). From July 2004 to June 2016, 58 LDs donated their RLs despite having moderate HS (30%-50% steatosis) determined by intraoperative biopsy at a single center. We performed greedy matching to compare the outcomes of the donors and recipients of this group with those of LDs with no HS. The mean left lobe (LL) HS value in the 58 cases was 20.9±12.4%, which was significantly lower than the mean RL HS value (38.8±6.7%, P<0.001). The mean ratio of the remnant LL to the total liver volume was 37.8±2.2. No differences were observed in the postoperative liver function and donor and recipient morbidity and mortality rates. The liver regeneration rates in recipients and donors at 1month, 6months, and 1year postoperatively did not differ significantly. The patient and graft survival rates of the recipients showed no differences. The use of well-selected RL grafts with moderate steatosis does not impair graft function, recipient outcomes, or donor safety.

Anterior sector outflow reconstruction using polytetrafluoroethylene (PTFE) graft in right lobe living donor liver transplantation

Presenter: Ashish Singhal MBBS, DNB | Fortis Hospitals Background: Outflow reconstruction is very important especially in right lobe (RL) LDLT without MHV. Preserving the MHV with donors add to donor safety but leads to multiple segmental veins in the graft. We aim to describe our surgical technique of anterior sector venous reconstruction using expanded polytetrafluroethylene (ePTFE) graft. Methods: Retrospective analysis of 760 primary RL-LDLTs between December 2011 and June 2018. On bench, we created a “Neo-MHV” using ePTFE graft and anastomosing to segment 5/8 veins in an end-to-end/end-to-side fashion. In past, graft RHV and Neo-MHV were anastomosed to IVC at separate sites. Since February 2016, the end of Neo-MHV was anastomosed with end of graft RHV in side-to-side fashion to create a common ostium and this was anastomosed to caval RHV orifice (single composite drainage). Reconstruction of AS: ePTFE (group A, n = 705) and autologous vein (group B, n = 55). Results: Pre-transplant characteristics were comparable among both groups. Group A has significantly lower CIT (68.7 ±.3.5 minutes vs. 127.8 ± 7.2 minutes; p <.001) and anhepatic time (116.3 ± 5.5 mins vs. 190.81 ± 9.35 mins; p < 0.001). There was no difference in recovery pattern of liver functions, morbidity, and mortality between the two groups. One and 6-months patency rates of interposition grafts were 97.6% and 84.4% (group A) and 96.4% and 78.1% (group B) respectively. Conclusion: In centers with limited access to homologous or autologous vascular grafts, use of ePTFE graft for AS venous outflow reconstruction in RL-LDLT is a viable option with excellent patency and patient outcomes.

Anterior Sector Outflow Reconstruction Using Polytetrafluoroethylene (PTFE) Graft in Right Lobe Living Donor Liver Transplantation

Background: Outflow reconstruction is very important especially in right lobe (RL) LDLT without MHV. Preserving the MHV with donors add to donor safety but leads to multiple segmental veins in the graft. We aim to describe our surgical technique of anterior sector venous reconstruction using expanded polytetrafluroethylene (ePTFE) graft.

Liver lobe based intravoxel incoherent motion diffusion weighted imaging in hepatitis B related cirrhosis: Association with child-pugh class and esophageal and gastric fundic varices.

Liver cirrhosis is a common chronic progressive liver disease in clinical practice, and intravoxel incoherent motion (IVIM) is a promising magnetic resonance method to assess liver cirrhosis, so our purpose was to investigate association of liver-lobe-based IVIM-derived parameters with hepatitis-B-related cirrhosis and its severity, and esophageal and gastric fundic varices. Seventy-four patients with hepatitis-B-related cirrhotic and 25 healthy volunteers were enrolled and underwent upper abdominal IVIM diffusion-weighted imaging with b-values of 0, 20, 50, 80, 100, 200, 400, 600, and 800 s/mm2. IVIM-derived parameters (D, pure molecular diffusion; D∗, pseudo diffusion; and f, perfusion fraction) of left lateral lobe (LLL), left medial lobe (LML), right lobe (RL), and caudate lobe (CL) were assessed statistically to show their associations with cirrhosis and its severity, and esophageal and gastric fundic varices. In this research, we found that D, D∗, and f values of LLL, LML, RL, and CL were lower in cirrhotic liver than in normal liver (all P-values <.05). D, D∗, and f values of LLL, LML, RL, and CL were inversely correlated with Child–Pugh class of cirrhosis (r = −0.236 to −0.606, all P-values <.05). D of each liver lobe, D∗ of LLL and CL, and f of LLL, LML, and CL in patients with esophageal and gastric fundic varices were lower than without the varices (all P-values <.05). D values of RL and CL could best identify cirrhosis, and identify esophageal and gastric fundic varices with areas under receiver-operating characteristic curve of 0.857 and 0.746, respectively. We concluded that liver-lobe-based IVIM-derived parameters can be associated with cirrhosis, and esophageal and gastric fundic varices.

332.3: Laparoscopic hepatectomy in living liver donors for transplantation in children: From implementation to routine use.

Background: During the last few years laparoscopic approach for living donor hepatectomy (LLDH) widely spread among high volume centers and proved its safety for donors and recipients. Our LLDH program was launched at 2016. Since this period the method established as routine for LLS donors. Analysis of own experience focused on LDLT in children was a subject of the study. Methods: 83 LLDH were performed between April 2016 and May 2019. Following graft types were procured laparoscopically: left lateral section (LLS) in 77 cases (including one case of combined LLDH and lap nephrectomy), left lobe (LL) in 5 (including combined case with lap nephrectomy) and right lobe (RL) in one case. Results: Average donors age was 30 (± 4,37) years. Mean intraoperative bloodless was 83 (± 29,6) ml. The mean operation time was 294 (± 48) min. Length of hospital was stay 4,3 (± 1.4) days. Follow up There was one Clavien grade IIIb complication, and three grade IIIa complications. Conversion to open surgery was carried out once due to technical complexity. Conclusions: Laparoscopic LLS safe and feasible for most of living donors. In the same time criteria for major LLDH still should be quite strict. Developed pediatric LDLT program can be a basis for successful implementation of LLDH.

Optimal Biliary Drainage for Patients With Biliary Anastomotic Strictures After Right Lobe Living Donor Liver Transplantation.

Right lobe (RL) living donor liver transplantation (LDLT) usually includes 2 bile duct anastomosis sites, namely, the right anterior and the right posterior segmental ducts. This study aimed to evaluate the optimal treatment for biliary strictures following RL LDLT with respect to unilateral or bilateral drainage techniques. From January 2005 to December 2017, 883 patients at Seoul National University Hospital underwent RL LDLT. Of these, 110 patients were enrolled who had 2 duct-to-duct anastomosis sites and who were considered at risk of developing biliary anastomotic strictures. Unilateral or bilateral biliary drainage during the follow-up period was identified by endoscopic retrograde cholangiopancreatography (ERCP) and/or percutaneous transhepatic biliary drainage (PTBD). The clinical success, complication, and 180-day mortality rates were compared between the unilateral and bilateral biliary drainage groups according to the initial ERCP findings. The mean age at the time of LDLT was 54.2±8.2 years. The median time from LDLT to initial biliary anastomotic strictures was 177 (interquartile range, 18-1085) days. At the initial ERCP, unilateral drainage was performed in 55 (50.0%) patients, and bilateral drainage was performed in 11 (10.0%) patients. Of the patients who underwent unilateral drainage, 35 (63.6%) patients required conversion to bilateral drainage during follow-up. Overall, 71 (64.5%) patients required bilateral drainage more than once, whereas only 27 (24.5%) patients reached a resolution with unilateral biliary drainage. In this study, most patients required bilateral biliary drainage more than once during follow-up. An active attempt should be made to drain bilaterally in patients with biliary anastomotic strictures following RL LDLT.

Sa1495 UNILATERAL VERSUS BILATERAL BILIARY DRAINAGE IN PATIENTS WITH BILIARY ANASTOMOTIC STRICTURES AFTER RIGHT-LOBE LIVING DONOR LIVER TRANSPLANTATION

Although there are usually two bile duct anastomosis sites including right anterior segmental duct (RASD) and right posterior segmental duct (RPSD) in right lobe (RL)-living donor liver transplantation (LDLT), studies comparing unilateral and bilateral biliary drainage are largely lacking. This study aimed to evaluate efficacy and safety of unilateral and bilateral biliary drainage in patients with biliary strictures following RL-LDLT.

Factors Affecting Liver Regeneration in Donors&amp;apos; Grafts in Living Donor Liver Transplant (LDLT) a Center Experience

Background: Liver regeneration for donors' graft in living donor liver transplantation (LDLT), is an example for liver regeneration in normal liver. In this study we spotted the light on liver regeneration in donors after LDLT, focusing on factors affecting it. Aim: To study the impact of different factors on liver regeneration in donors of living donor liver transplantation. Patients and methods: Between May 2013 and June 2019, 80 living donor liver transplants were performed in the liver transplant unit in EL-Maadi Armed Forces Hospital. All donors who provided liver grafts underwent volumetric spiral computed tomography (CT) scans preoperatively and postoperatively at time intervals of 1 week and 1, 3 and 6 months. Patients’ demographics, surgical data, and postoperative outcomes were correlated with liver regeneration data. 63 patients were males and 17 patients were females, with mean age 27.97yrs ± 5.3. They provided {72} right lobe (RL) grafts and 8 right posterior sector (RP) grafts. Results: No donor operation was aborted and surgical morbidity rate was {33.75%}, mostly biliary. All RP donors achieved complete liver regeneration after 3 months; only four RL donors achieved complete liver regeneration at 6 months. Conclusion: In this study, it was found that there were factors affecting regeneration like age, gender of the patient and graft size. But no effect was found with many factors as peri-operative liver function tests, steatosis, BMI, operative time, blood loss, blood transfusion and postoperative complications.

Strategy for selective middle hepatic vein reconstruction in living donor liver transplantation using right lobe graft

Introduction: In living donor liver transplantation (LDLT) using right lobe(RL) graft, the standardized technique for procuring the graft does not include middle hepatic vein (MHV) trunk and is left to the donor side. This procedure may increase the congestion area in the graft after reperfusion. To overcome such difficulties, MHV reconstruction is widely being performed at the bench procedure. However in the basis of sufficient right hepatic vein territory(RHV) this procedure can be extravagant. The aim of this study is to verify the safety and feasibility of our policy for MHV reconstruction in LDLT using RL graft. Method: 153 LDLTs, using right hemiliver grafts were performed in a tertiary hospital from 2006 to 2016. Among them, 52 selected cases where MHV reconstruction was not performed were compared with 101 recipients who underwent LDLT using right lobe graft with MHV reconstruction. Both groups were compared regarding indications for reconstruction, short-term and long-term complications and operative details and outcomes Result: Two groups differed only in cold ischemic time (108.19 49.81 versus 146.37 58.74 minutes), preoperatively. Also, no statistical difference was seen, regarding short-term post-transplant outcomes and long-term overall and disease-free survival rates. After propensity score matching in both groups with and without MHV reconstruction to annihilate selection bias, two groups were comparable. Conclusion: We found that our selection criteria, whether to reconstruct MHV in LDLT, using right hemiliver graft is feasible and safe.

The severity of LPS induced inflammatory injury is negatively associated with the functional liver mass after LPS injection in rat model

BackgroundHigh levels of serum lipopolysaccharide (LPS) were observed in sepsis patients with liver injury and high mortality. However, the role of liver in modulation LPS induced inflammatory injury was ill investigated. In the present study, the severity of LPS induced inflammatory response was observed after liver resection or portal branch occlusion to decreasing functional liver mass. The local and systemic damage was observed to investigate the role of liver in modulation inflammatory injury.MethodsFirst, 30%, 70%, and 90% partial hepatectomy (PH) were performed, and serum TNF-α, survival rate, and hepatic LPS uptake was observed. Second, LPS-exposure of the functional liver mass was decreased by selectively blocking the RL prior to LPS-injection, which was given 30 min before a 70% PH, and the inflammatory response was compared in the occluded and the non-occluded liver. The control group was subjected to LPS injection 30 min prior to liver resection without blocking the RL transiently. The serum TNF-α, ALT, AST, creatinine levels, and urea levels, survival rate, hepatic LPS uptake, and hepatic inflammatory cytokines was observed.ResultsThe decreasing of functional liver mass after 90%, 70%, and 30% PH was associated with decreased serum TNF-α, survival rate, and increased hepatic LPS uptake after LPS injection. Occluding the right lobes (RL) prior to LPS administration reversed the liver injury caused by 70% PH, indicated by 100% survival rate and decreased liver and kidney injury, and systemic inflammatory response. The induction of inflammatory response in occluding liver lobes were lower than un-occluding liver lobes.ConclusionsThe severity of the LPS-induced systemic inflammatory injury is determined by functional liver volume. This observation suggests that the liver is the central organ for the initiation of the inflammatory response, and is involved in causing a severe SIRS with systemic damage and death.

Readdressing the Middle Hepatic Vein in Right Lobe Liver Donation: Triangle of Safety

For equipoising donor safety and optimal recipient outcomes, we adopted an algorithmic "triangle of safety" approach to retrieve 3 types of right lobe liver grafts (RLGs), namely, the modified extended right lobe graft (MERLG), the partial right lobe graft (PRLG), and the modified right lobe graft (MRLG). Reconstruction to achieve a single wide anterior sector outflow was ensured in all patients. We present donor and recipient outcomes based on our approach in 665 right lobe (RL) living donor liver transplantations (LDLTs) performed from January 2013 to August 2015. There were 347 patients who received a MERLG, 117 who received a PRLG, and 201 who received a MRLG. A right lobe graft (RLG) with a middle hepatic vein was retrieved only in 3 out of 18 donors with steatosis >10%. Cold ischemia time was significantly more and remnant volume was less in the MRLG group. Of the donors, 29.3% had complications (26% Clavien-Dindo grade I, II) with no statistically significant difference among the groups. The Model for End-Stage Liver Disease score was higher in the MERLG group. There were 34 out of 39 with a graft-to-recipient weight ratio (GRWR) of <0.7% who received a MERLG with inflow modulation. Out of 4 patients who developed small-for-size syndrome in this group, 2 died. The 90-day patient survival rate was similar among different GRWRs and types of RLG. In conclusion, a selective and tailored approach for RL donor hepatectomy based on optimal functional volume and metabolic demands not only addresses the key issue of double equipoise in LDLT but also creates a safe path for extending the limits.

Accuracy of preoperative CT liver volumetry in living donor hepatectomy and its clinical implications.

An accurate preoperative volumetric assessment of donor liver is essential for successful living donor liver transplant by ensuring adequate remnant and graft recipient weight ratio (GRWR). The study cohort consisted of 744 right lobe (RL), 65 left lobe (LL) and 33 left lateral sector (LLS) grafts from July 2010 to January 2014. A semi-automated interactive commercial software called AW Volume share 6 was used for volumetry. Bland Altman plot was used for assessing the agreement between estimated graft weight (EGW) and actual graft weight (AGW). There was no statistically significant difference between EGW and AGW for RL graft weight (722±134 vs. 717±126 gm; P=0.06). Although Bland Altman graph showed that 95% limits of agreement was more in LL (-164 to +110) than RL (-156 to +147) and LLS grafts (-137 to +239), CT scan significantly overestimated LL graft weight (EGW =460±118 gm vs. AGW =433±102 gm; P=0.003) and underestimated LLS graft weight (EGW =203±48 gm vs. AGW =254±49 gm; P<0.001). CT volumetry overestimate LL graft and underestimate LLS graft weight. This should be factored in when selecting LL graft by taking higher GRWR.

Surgical Complications after Right Hepatectomy for Live Liver Donation: Largest Single-Center Western World Experience.

The authors assessed the incidence, management, and risk factors for postoperative complications after right lobe (RL) live donor hepatectomy in a high-volume center in North America. All donors undergoing an RL live donor hepatectomy between 2000 and 2017 at our institution were included. The primary outcome was the development of complications (both medical and surgical). Predictors of postoperative complications were determined by logistic regression. A total of 587 patients underwent RL live donor hepatectomy. Among those, 187 postoperative complications were diagnosed in 141 (24%) patients. One patient had >90-day morbidity, and there were no donor deaths. Overall complications were significantly higher in the first era, 2000 to 2008 (81 [57.4%]) versus the second era, 2009 to 2017 (60 [42.6%]) (p = 0.01). On multivariate analysis, the only predictor of postoperative complications was the center volume of RL live donor hepatectomy in the previous 12 months with an odds ratio of 0.97 (95% confidence interval: 0.95-0.99). In conclusion, increasing center volume is associated with lower rates of postoperative complications after RL living liver donation.

Right lobe donor hepatectomy: is it safe? A retrospective study.

Donor safety is utmost important in Living donor liver transplantation (LDLT). Small for size syndrome in some recipients with left lobe donors led to the evolution of right lobe LDLT. The aim of the study was to analyze the safety of large series of right lobe (RL) donor hepatectomies and compare outcomes with left lobe (LL) and left lateral segment (LLS) donations. A consecutive cohort of 726 donors from January 2011 to January 2014 were studied; RL (n=641, 88.3%), LL (n=36, 4.9%) or LLS (n=49, 6.8%) depending on the type of donation. The mean age was 34.6±10years. The overall complication rate was 22.3%. Most were Clavien grade I and II. Clavien grade IIIa, IIIb, IV and V were noted in 4.2% donors. The incidence of these major complications were comparable among RL (n=28, 4.2%), LL (n=1, 2.7%) and LLS (n=2, 4.08%) (P=0.89). Bile leak was seen in 20 donors (2.7%) and 13 were managed conservatively with prolonged or additional intra-abdominal drainage. Seven underwent re-exploration for bile leak. In centres experienced in right lobe LDLT, morbidity after RL donation is similar to that of LL donation; and with adequate GRWR, same 1-year recipient outcomes.