Measures for increasing the safety of donors in living donor liver transplantation using right lobe grafts.
BACKGROUND
The safety of donors in living donor liver transplantation (LDLT) should be the primary consideration. The aim of this study was to report our experience in increasing the safety of donors in LDLTs using right lobe grafts.


METHODS
We retrospectively studied 37 living donors of right lobe grafts from January 2002 to March 2006. The measures for increasing the safety of donors in LDLT included carefully selected donors, preoperative evaluation by ultrasonography, angiography and computed tomography; and necessary intraoperative cholangiography and ultrasonography. Right lobe grafts were obtained using an ultrasonic dissector without inflow vascular occlusion on the right side of the middle hepatic vein. The standard liver volume and the ratio of left lobe volume to standard liver volume were calculated.


RESULTS
There was no donor mortality in our group. Postoperative complications only included bile leakage (1 donor), biliary stricture (1) and portal vein thrombosis (1). All donors recovered well and resumed their previous occupations. In recipients, complications included acute rejection (2 patients), hepatic artery thrombosis (1), bile leakage (1), intestinal bleeding (1), left subphrenic abscess (1) and pulmonary infection (1). The mortality rate of recipients was 5.4% (2/37); one recipient with pulmonary infection died from multiple organ failure and another from occurrence of primary disease.


CONCLUSIONS
The first consideration in adult-to-adult LDLT is the safety of donors. The donation of a right lobe graft is safe for adults if the remnant hepatic vasculature and bile duct are ensured, and the volume of the remnant liver exceeds 35% of the total liver volume.
Wen
Tian-Fu
TF
Division of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, China.
Chen
Zhe-Yu
ZY
Yan
Lu-Nan
LN
Li
Bo
B
Zeng
Yong
Y
Zhao
Ji-Chun
JC
Wang
Wen-Tao
WT
Yang
Jia-Yin
JY
Ma
Yu-Kui
YK
Xu
Ming-Qing
MQ
Liu
Jiang-Wen
JW
Deng
Zhi-Gang
ZG
Wu
Hong
H
D000328:Adult; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000098:blood supply; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012449:Safety; D016896:Treatment Outcome