[Clinical study of adult to adult living donor liver transplantation: a report of 56 cases].
OBJECTIVE
To investigate the ways to ensure the safety of donors and recipients in adult-to-adult living donor liver transplantation (A-ALDLT).


METHODS
From January 2002 to September 2006, 56 A-ALDLT were performed in our division, including 52 cases of right lobe graft were obtained without medial hepatic vein (MHV) and 4 cases of dual grafts (1 case using two left lobes, 3 cases using 1 right and 1 left lobe). The most common diagnoses were hepatitis B liver cirrhosis (62.5%) and hepatocellular carcinoma (30.4%) in recipients. Among them, 10 cases scored more than 25 with the model of end-stage liver disease (MELD) scoring system. Triphasic liver computed tomography were used for reconstruction of hepatic vessels and to calculate total liver and right liver volumes in donors. Various innovative surgical techniques were adopted too.


RESULTS
From the 58 living donors, 55 right lobes and 3 left lobes were obtained. The 55 right lobe grafts were obtained without medial hepatic vein, weighed 400 approximately 860 g (median 550 g). The ratio of graft volume to recipient standard liver volume ranged from 31.7% to 71.7% (median 45.4%). All donors' remnant liver volumes were over 35% of the total liver volume. There was no donor mortality, but 7 (12.5%) donors experienced complications. Of the 56 recipients, with a follow-up period of 2 approximately 52 months (median 11 months), 15 (26.8%) developed complications and 4 (7.2%) died within 3 months post operation. The 1-year actual survival rate was 92.8%.


CONCLUSIONS
When preoperative CT volume shows remnant liver volume is greater than 35% of the total liver volume, and graft volume to recipient's standard liver volume ratio is over 40%, A-ALDLT using right lobe graft is a safe procedure for both donors and recipients, otherwise the dual graft liver transplantation should be considered.
Yan
Lü-nan
LN
Transplantation Division, Department of Surgery, West China Hospital, Sichuan University, Chengdu, China. yanlunan688@163.com
Li
Bo
B
Zeng
Yong
Y
Wen
Tian-fu
TF
Wang
Wen-tao
WT
Yang
Jia-yin
JY
Xu
Ming-qing
MQ
Chen
Zhe-yu
ZY
Zhao
Ji-chun
JC
Ma
Yu-kui
YK
Wu
Hong
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D020858:Tissue and Organ Harvesting / Q000379:methods