Adult-to-adult living donor liver transplantation using left lobes: the importance of surgical modulations on portal graft inflow.
BACKGROUND
Due to the shortage of available cadaveric organs, living donor liver transplantation (LDLT) has been recently applied extensively in adults. The use of the left lobe should be encouraged because of donor safety, but frequently the metabolic requirements of severely cirrhotic patients are great and subsequent graft dysfunction is encountered after transplantation. The importance of increased portal inflow to the graft in previously severely cirrhotic patients and other hemodynamic changes in LDLT using left lobes are still under debate, as are the surgical modulations to correct them. In this study, we have reported an initial series of adult-to-adult LDLT using left lobes, underlining the hemodynamic changes encountered during the transplant and the surgical modulations we applied to correct them.


METHODS
Eight adult recipients underwent left lobe liver transplantation from living donors. Portal vein pressure and central venous pressure were measured before and after surgical modulation.


RESULTS
We encountered four cases of small-for-size syndrome. Two patients were retransplanted; the other two died. Seventy-five percent of our recipients survived and 50% did not require further surgery.


CONCLUSIONS
Surgical portal inflow modulation should be considered in cases of left lobe liver transplantation between adults.
Lauro
A
A
Liver and Multiorgan Transplant Unit, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy. augustola@yahoo.com
Diago Uso
T
T
Quintini
C
C
Di Benedetto
F
F
Dazzi
A
A
De Ruvo
N
N
Masetti
M
M
Cautero
N
N
Risaliti
A
A
Zanfi
C
C
Ramacciato
G
G
Begliomini
B
B
Siniscalchi
A
A
Miller
C M
CM
Pinna
A D
AD
D000328:Adult; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D019520:Living Donors; D016343:Monitoring, Intraoperative; D011168:Portal System / Q000502:physiology*; D012086:Reoperation; D012189:Retrospective Studies; D013156:Splenectomy; D016019:Survival Analysis; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome