Clinical significance of right hepatectomy along the main portal fissure on donors in living donor liver transplantation.
There might be discordance between inter-lobar borders of the main portal fissure (MPF) using the middle hepatic vein (MHV) and of the portal segmentation. Forty-five living donors who underwent right hepatectomy for the adult recipients from 2007 to 2011 in a tertiary hospital were retrospectively analyzed. The donors were classified into conventional right hepatectomy along the MPF (cRL group, n = 26) and modified right hepatectomy along right-side shifted transection plane from the MPF (mRL group, n = 19). The cRL donors had higher postoperative peak level of INR (1.84 vs. 1.62; P = 0.022), and bilirubin (3.37 mg/dl vs. 2.74 mg/dl; P = 0.065) than the mRL donors. cRL donors experienced greater depression of platelet count (144 per nL vs. 168 per nL; P = 0.042) and enlargement of splenic volume (52% vs. 37%; P = 0.025) than mRL donors for 7 days after hepatectomy. The regeneration of the left lateral sector was more accelerated in the cRL donors than the mRL donors for postoperative 3 months (148% vs. 84%; P = 0.015). There were no differences in the post-transplant graft function, incidence of complications, and graft survival rates between the two groups of recipients (P > 0.05). This study suggests that the conventional right hepatectomy along the MHV might increase donor risk by reducing parenchymal liver volume of the segment IV.
Department of Hepatobiliary Surgery and Liver Transplantation, Ajou University School of Medicine, Suwon, Korea. drbwkim@ajou.ac.kr
Bong-Wan
BW
Kim
Yong-Keun
YK
Park
Weiguang
W
Xu
Hee-Jung
HJ
Wang
Jae-Myeong
JM
Lee
Kwangil
K
Lee
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D005260:Female; D006085:Graft Survival; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000473:pathology; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000601:surgery*; D017093:Liver Failure / Q000000981:diagnostic imaging / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies