title: Left hepatectomy versus right hepatectomy for living donor liver transplantation: shifting the risk from the donor to the recipient.
abstract: Living donor liver transplantation (LDLT), originally used in children with left lateral segment grafts, has been expanded to adults who require larger grafts to support liver function. Most adult LDLT procedures have been performed with right lobe grafts, and this means a significant risk of morbidity for the donors. To minimize the donor risk for adults, there is renewed interest in smaller left lobe grafts. The smaller graft size increases the recipient risk in the form of small-for-size syndrome (SFSS) and essentially transfers the risk from the donor to the recipient. We review the donor and recipient risks of LDLT and pay particular attention to the different types of liver grafts and the use of graft inflow modification to ameliorate the risk of SFSS. Finally, a new metric is proposed for quantifying the recipient benefit in exchange for a specific donor risk.
authors: Division of Transplantation, Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
authors: Garrett R
authors: GR
authors: Roll
authors: Justin R
authors: JR
authors: Parekh
authors: William F
authors: WF
authors: Parker
authors: Mark
authors: M
authors: Siegler
authors: Elizabeth A
authors: EA
authors: Pomfret
authors: Nancy L
authors: NL
authors: Ascher
authors: John Paul
authors: JP
authors: Roberts
mesh_terms: D000328:Adult; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D019520:Living Donors; D009017:Morbidity; D012306:Risk