title: "Left at right" adult liver transplantation: the feasibility of heterotopic implantation of left liver graft.
abstract: Left liver grafts have been widely utilized in adult liver transplantation (LT) and yielded acceptable results. However, the conventional orthotopic implantation of a left liver graft imposes the potential risk of perioperative vascular complications. We report herein an alternative modified technique for adult left liver LT and evaluate its feasibility in LT. In this study, 10 recipients had their left liver graft rotated 180°, and heterotopically implanted at the right subphrenic space, which we termed "left at right" liver transplantation (LAR-LT). The sequence of vascular and biliary reconstruction was performed as standard techniques, and no perioperative vascular complications related to LAR-LT were encountered. There were two mortalities in this series, one due to a small-for-size graft dysfunction and the other due to postoperative internal hemorrhage. Two recipients had biliary strictures that were successfully managed by percutaneous biliary dilatation and Roux-en-Y hepaticojejunostomy. The clinical characteristics and outcomes of patients undergoing LAR-LT were also compared with patients undergoing conventional orthotopic left liver LT (n = 14). Although the results showed no significant difference between the two groups, according to our experience, the satisfactory outcome and easier technical reconstruction suggest that the LAR-LT modification could be a feasible alternative to left liver LT.
authors.affiliation: Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: K-M
authors.initials: KM
authors.lastname: Chan
authors.forename: F Z
authors.initials: FZ
authors.lastname: Eldeen
authors.forename: C-F
authors.initials: CF
authors.lastname: Lee
authors.forename: T-J
authors.initials: TJ
authors.lastname: Wu
authors.forename: H-S
authors.initials: HS
authors.lastname: Chou
authors.forename: T-H
authors.initials: TH
authors.lastname: Wu
authors.forename: R-S
authors.initials: RS
authors.lastname: Soong
authors.forename: W-C
authors.initials: WC
authors.lastname: Lee
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D014019:Tissue Donors