[Preliminary results of adult-to-adult living donor liver transplantation: improved size matching and better outcomes with right lobe versus left lobe grafts].

UNLABELLED: Grafts from living donors are a novel alternative to cadaveric organs for adult liver recipients.

METHODS: Twenty adults (mean age, 46 +/- 15 years; mean weight, 68 +/- 12 kg) received left lobes (n = 10; mean weight, 481 +/- 73 g) or right lobes (n = 10; mean weight, 805 +/- 115 g) from living donors (mean age, 38 +/- 10 years; mean weight, 85 +/- 9 kg). Hepatectomy was done using ultrasonic scissors, without vascular isolation. Transplantation was performed in a piggy-back fashion. Biliary reconstruction was performed with a single hepatico-enterostomy to the left duct for LL grafts and with 2 (n = 8) or 3 (n = 2) hepatico-enterostomies in RL grafts.

RESULTS: All donors recovered without significant complications or heterologous transfusion. Three recipients (15%) died. Graft survival is 70% (mean follow-up, 8 months). Mean graft: recipient weight ratios (GRWR) were 0.75% +/- 0.21% (range, 0.51-1.06) in LL recipients, and 1.10% +/- 0.15% (range, 0.93-1.44) in RL recipients. Four recipients of relatively small LL grafts (GRWR < 0.8%), all with Child's B or C cirrhosis, developed small-for-size syndrome. One died; 2 required retransplantation. Small LL grafts were used successfully in Child's A patients or non-cirrhotics (the indication for transplantation was tumor). The LL group had 5 bile leaks (50%) and 3 major vascular complications (30%). One was fatal; 1 mandated retransplantation. The RL group had 2 biliary leaks (20%) and 1 hepatic artery thrombosis, which necessitated retransplantation.

CONCLUSIONS: Right lobe grafts prevented small-for-size syndrome. Although donor hepatectomy and recipient grafting are technically more demanding, right lobe grafting seems to involve fewer recipient complications and better outcome.