title: Strategies for successful left-lobe living donor liver transplantation in 250 consecutive adult cases in a single center.
abstract: BACKGROUND
  Living donor liver transplantation (LDLT) using left-lobe grafts was not generally recognized as feasible due to the problem of graft size.
  
  
  METHODS
  We retrospectively evaluated strategies for successful left-lobe LDLT in 250 consecutive cases stratified into 2 eras: Era 1 (n = 121), in which surgical procedures were continually refined, and Era 2 (n = 129), in which established procedures were used.
  
  
  RESULTS
  Graft volume (GV) did not affect the incidence of graft function or survival. Era 2 patients had decreased portal vein (PV) pressure at closure (16.0 ± 3.5 mmHg vs 19.1 ± 4.6 mmHg, p < 0.01), increased PV flow/GV (301 ± 125 mL/min/100g vs 391 ± 142 mL/min/100g, p < 0.01), and improved graft survival rate (1-year: 90.6% vs 81.8%. p < 0.01) despite the smaller GV/standard volume (SLV) ratio (36.2% ± 5.2% vs 41.2% ± 8.8%, p < 0.01) compared with Era 1. Patients in Era 2 had lower PV pressure and greater PV flow (y = 598-5.7 x, p = 0.02) at any GV/SLV compared with cases in Era 1 (y = 480-4.3 x, p < 0.01), representing greater graft compliance. Univariate analysis for graft survival showed that Era 1, Model for End-Stage Liver Disease (MELD) score ≥ 20, inpatient status, closing portal venous pressure ≥ 20 mmHg, no splenectomy, and operative blood loss ≥ 10 L were the risk factors for graft loss, and multivariate analysis showed that Era 1 was the only significant factor (p < 0.01). During Era 2, development of primary graft dysfunction was associated with inpatient recipient status (p = 0.02) and donor age ≥ 45 years (p < 0.01).
  
  
  CONCLUSIONS
  The outcomes of left-lobe LDLT were improved by accumulated experience and technical developments.
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. tikesurg@yahoo.co.jp
authors: Toru
authors: T
authors: Ikegami
authors: Ken
authors: K
authors: Shirabe
authors: Yuji
authors: Y
authors: Soejima
authors: Tomoharu
authors: T
authors: Yoshizumi
authors: Hideaki
authors: H
authors: Uchiyama
authors: Yo-ichi
authors: Y
authors: Yamashita
authors: Norifumi
authors: N
authors: Harimoto
authors: Takeo
authors: T
authors: Toshima
authors: Shohei
authors: S
authors: Yoshiya
authors: Tetsuo
authors: T
authors: Ikeda
authors: Yoshihiko
authors: Y
authors: Maehara
mesh_terms: D000328:Adult; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D015999:Multivariate Analysis; D011169:Portal Vein / Q000503:physiopathology; D055031:Primary Graft Dysfunction / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013156:Splenectomy; D016896:Treatment Outcome; D014690:Venous Pressure