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  • Title: Strategies for successful left-lobe living donor liver transplantation in 250 consecutive adult cases in a single center.
    Author: Ikegami T, Shirabe K, Soejima Y, Yoshizumi T, Uchiyama H, Yamashita Y, Harimoto N, Toshima T, Yoshiya S, Ikeda T, Maehara Y.
    Journal: J Am Coll Surg; 2013 Mar; 216(3):353-62. PubMed ID: 23318119.
    Abstract:
    BACKGROUND: Living donor liver transplantation (LDLT) using left-lobe grafts was not generally recognized as feasible due to the problem of graft size. STUDY DESIGN: We retrospectively evaluated strategies for successful left-lobe LDLT in 250 consecutive cases stratified into 2 eras: Era 1 (n = 121), in which surgical procedures were continually refined, and Era 2 (n = 129), in which established procedures were used. RESULTS: Graft volume (GV) did not affect the incidence of graft function or survival. Era 2 patients had decreased portal vein (PV) pressure at closure (16.0 ± 3.5 mmHg vs 19.1 ± 4.6 mmHg, p < 0.01), increased PV flow/GV (301 ± 125 mL/min/100g vs 391 ± 142 mL/min/100g, p < 0.01), and improved graft survival rate (1-year: 90.6% vs 81.8%. p < 0.01) despite the smaller GV/standard volume (SLV) ratio (36.2% ± 5.2% vs 41.2% ± 8.8%, p < 0.01) compared with Era 1. Patients in Era 2 had lower PV pressure and greater PV flow (y = 598-5.7 x, p = 0.02) at any GV/SLV compared with cases in Era 1 (y = 480-4.3 x, p < 0.01), representing greater graft compliance. Univariate analysis for graft survival showed that Era 1, Model for End-Stage Liver Disease (MELD) score ≥ 20, inpatient status, closing portal venous pressure ≥ 20 mmHg, no splenectomy, and operative blood loss ≥ 10 L were the risk factors for graft loss, and multivariate analysis showed that Era 1 was the only significant factor (p < 0.01). During Era 2, development of primary graft dysfunction was associated with inpatient recipient status (p = 0.02) and donor age ≥ 45 years (p < 0.01). CONCLUSIONS: The outcomes of left-lobe LDLT were improved by accumulated experience and technical developments.
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