title: Excellent outcome in 238 consecutive living donor liver transplantations using the right liver graft in a large volume single center.
abstract: BACKGROUND
  Using a right liver (RL) graft improves the outcomes in adult living donor liver transplantation (ALDLT). Here we report the recent excellent outcomes of 238 consecutive RL transplantations in ALDLT.
  
  
  METHODS
  Between January 2005 and June 2009, 238 consecutive adult recipients underwent RL transplantation; The middle hepatic vein (MHV) was reconstructed using artificial vascular grafts in 209 cases. Among these study subjects, UNOS status 1 and 2A were 12 (5.0 %) and 20 (8.4 %) patients, and the mean medical MELD score, was 19.9. Hepatitis B virus was the most common original liver disease in 184 patients (77.3 %). Hepatocellular carcinoma was diagnosed in 133 patients (56.3 %), and 102 patients (76.1 %) met the radiologic Milan criteria. The mean graft-versus-recipient weight ratio was 1.14 %. The primary endpoint of this study was the patient and graft survival rate. The mean follow-up period was 32 (0-69) months.
  
  
  RESULTS
  The most common major complication was biliary complication (n = 62; 26 %). The 1-, 2-, and 5-year patient survival rates were 96, 95, and 94 %, and the graft survival rates were 99, 99, and 98 %. There were 4 hospital deaths (1.6 %). Eighteen late mortalities were observed after recurrence of hepatocellular carcinoma (HCC, n = 17) and one case of lymphoma recurrence. One case of graft failure 33 months after ALDLT was attributed to cholestatic fibrosing hepatitis B saved by re-ALDLT. On multivariate analysis, no drainage of MHV branches and accompanying HCC beyond Milan criteria were the risk factors for poor patients' survival rate (p < 0.05).
  
  
  CONCLUSIONS
  Further technical innovation would be required to overcome biliary complications. The technical innovation using right liver draining MHV branches improved both patient and graft survival outcomes of ALDLT. Despite these advances, selection criteria for HCC are still hurdles, even in RL transplantation.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul National University, 101 Daehak-ro Chongro-gu, Seoul, 110-744, Korea.
authors.forename: Nam-Joon
authors.initials: NJ
authors.lastname: Yi
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
authors.forename: Suk-Won
authors.initials: SW
authors.lastname: Suh
authors.forename: Ye Rim
authors.initials: YR
authors.lastname: Chang
authors.forename: Geun
authors.initials: G
authors.lastname: Hong
authors.forename: Tae
authors.initials: T
authors.lastname: Yoo
authors.forename: Hyeyoung
authors.initials: H
authors.lastname: Kim
authors.forename: Min Su
authors.initials: MS
authors.lastname: Park
authors.forename: Young Rok
authors.initials: YR
authors.lastname: Choi
authors.forename: Kwang-Woong
authors.initials: KW
authors.lastname: Lee
authors.forename: Chul-Woo
authors.initials: CW
authors.lastname: Jung
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Yoon Jun
authors.initials: YJ
authors.lastname: Kim
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Yoon
authors.forename: Hyo-Suk
authors.initials: HS
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome