Prevent small-for-size syndrome using dual grafts in living donor liver transplantation.
BACKGROUND
The growing gap between the number of patients waiting for transplantation and available organs is still the main issue facing the transplant community. The major limitation of adult-to-adult living donor liver transplantation (LDLT) is the small-for-size problem because of the concern of donor safety. We report preliminary experiences for preventing small-for-size syndrome using dual grafts from one right lobe without the middle hepatic vein and one left lateral segment in adult-to-adult LDLT.


METHODS
One hundred ten cases of adult-to-adult LDLT were performed in West China Hospital of Sichuan University from January 2002 to August 2007, and there were 16 small-for-size (SFS) grafts in all grafts. Dual grafts LDLT was performed for six patients with end-stage liver disease, consisting of five cases from one right lobe without the middle hepatic vein and one left lateral segment, and one case from two left lobes.


RESULTS
All living donors underwent a full recovery from the operation without persistent complications. Four recipients died of sepsis, one recipient received re-transplantation, and three recipients received transplenic artery embolization in the recipients with SFS grafts. All recipients with dual grafts displayed good graft function and a majority of grafts showed normal triangular-shape regeneration of their respective liver grafts. Only in one left lateral segment atrophy occurred, graft hepatectomy was not required.


CONCLUSIONS
Dual grafts from one right lobe without the middle hepatic vein and one left lateral segment in adult-to-adult LDLT can prevent the small-for-size problem and yet secure the safety of the donors.
Chen
Zheyu
Z
Department of Hepato-bilio-pancreatology Surgery and Division of Liver Transplantation, West China Hospital, West China Medical School of Sichuan University, Chengdu, China.
Yan
LuNan
L
Li
Bo
B
Zeng
Yong
Y
Wen
TianFu
T
Zhao
JiChun
J
Wang
WenTao
W
Xu
MingQing
M
Yang
Jiayin
J
D000328:Adult; D049628:Body Size / Q000502:physiology*; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D008099:Liver / Q000601:surgery; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D008115:Liver Regeneration / Q000502:physiology; D016031:Liver Transplantation / Q000379:methods* / Q000502:physiology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013577:Syndrome; D016896:Treatment Outcome