Donor selection for procurement of right posterior segment graft in living donor liver transplantation.
The right posterior segment (RPS) graft was introduced to overcome graft-size mismatch when the donor liver demonstrates a disproportionately small left lobe (LL). As variants of liver anatomy seemed to be related to the feasibility of RPS graft procurement, in 2003, we performed a prospective study to assess its feasibility in 197 consecutive living donors. Variants of the portal vein (PV) were classified as type I (bifurcation), II (trifurcation), and III (independent RPS PV branching from main PV). The right hepatic artery, vein, and bile duct were also classified according to their branching pattern and location. PV variations were type I in 157 (79.7%) donors, type II in 15 (7.6%) donors, and type III in 25 (12.7%) donors. Mean volume proportion of LL plus caudate lobe was 35.3 +/- 3.8% (range 24-4) of the whole liver volume (WLV). On exclusion of donors with LL greater than 35% of WLV, there were 14 (7.1%) donors revealing RPS greater than LL by over 3% of WLV. Of these 14 donors, 3 had type I PV with artery or bile duct anatomy not suitable for RPS procurement. One donor with type II PV and 9 out of 10 donors with type III PV met the anatomical conditions for RPS graft procurement. With the exclusion of caudate lobe volume, LL volume became less than 30% of WLV in all of these 14 donors. We successfully procured 3 RPS grafts, all with type III PV, out of 197 consecutive living donors. In conclusion, successful RPS graft procurement is highly possible, only when LL is disproportionately small (<30% of WLV) and the PV variant is type III.
Hwang
Shin
S
Department of Surgery, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Ulsan University College of Medicine, Seoul, Korea.
Lee
Sung-Gyu
SG
Lee
Young-Joo
YJ
Park
Kwang-Min
KM
Kim
Ki-Hun
KH
Ahn
Chul-Soo
CS
Sung
Kyu-Bo
KB
Moon
Deok-Bog
DB
Ha
Tae-Yong
TY
Kim
Keon-Kuk
KK
Kim
Yeon-Dae
YD
D000293:Adolescent; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008099:Liver / Q000033:anatomy & histology; D016031:Liver Transplantation / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011169:Portal Vein / Q000033:anatomy & histology; D011446:Prospective Studies