ABSTRACT
OBJECTIVES: Living-donor liver transplant with small-for-size grafts (graft-to-recipient weight ratio < 0.8) may provide satisfactory results. We compared outcomes between right and left donor lobe in living-donor liver transplant. MATERIALS AND METHODS: Patients who had living-donor liver transplant from 2006 to 2008 with graft-to-recipient weight ratio < 0.8 (graft: right lobe, 24 patients; left lobe, 26 patients) were reviewed retrospectively. RESULTS: There were no significant differences in demographic and preoperative clinical data between patients who received a right or left lobe liver graft. Duration of surgery was longer, cold ischemia time was shorter, and mean baseline portal vein flow was greater in transplants performed with left than right donor lobes. Portal vein flow modulation with splenectomy was performed when portal flow was > 250 mL/min/100 g graft. Small-for-size syndrome was observed in 6 recipients (14%), but no patient who developed small-for-size syndrome developed liver failure or required revision transplant. The frequency of small-for-size syndrome was significantly greater in patients who had left lobe (4 patients [15%]) than right lobe transplant (2 patients [8%]; P ≤ .05). Graft dysfunction-free survival was significantly greater with right than left lobe grafts. In multivariate analysis, graft side was the only significant risk factor for small-for-size syndrome. CONCLUSIONS: In patients having living-donor liver transplant with small-for-size grafts, outcome was better with right than left lobe grafts.
Subject(s)
Liver Transplantation/methods , Liver/surgery , Living Donors , Blood Flow Velocity , Chi-Square Distribution , Cold Ischemia , Disease-Free Survival , Female , Humans , Kaplan-Meier Estimate , Liver/pathology , Liver Circulation , Liver Transplantation/adverse effects , Logistic Models , Male , Middle Aged , Multivariate Analysis , Operative Time , Organ Size , Portal Vein/physiopathology , Portal Vein/surgery , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Retrospective Studies , Risk Factors , Splenectomy , Time Factors , Treatment OutcomeABSTRACT
INTRODUCTION: Liver grafts can at times have two hepatic arterial stumps. This can result in a dilemma whether to reconstruct single or both the arteries. Hepatic artery (HA) thrombosis is the most dreaded complication in pediatric living donor liver transplantation (LDLT) as it can result in biliary complications and subsequent graft loss. We herein report the feasibility of reconstructing single hepatic artery in pediatric living donor liver transplantation having two arterial stumps in the liver graft. MATERIALS AND METHODS: From 2008 to 2010, 87 pediatric patients undergoing LDLT were divided into three groups. Group 1 (n = 20): two HA stumps with two HA reconstruction, Group 2 (n = 22): two HA stumps with one HA reconstruction and Group 3 (n = 45): one HA stump with one HA reconstruction. The decision regarding the reconstruction of single or multiple HAs was made depending on the pre-operative radiological and intraoperative assessments. RESULTS: The incidence of HA thrombosis (p = 0.126) and biliary complications (p = 0.617), was similar in the three groups. CONCLUSION: Single HA reconstruction does not increase the risk of biliary strictures in pediatric LDLT recipients having dual hepatic arterial stumps in the liver graft.
