ADULT-TO-ADULT LIVING DONOR LIVER-TRANSPLANTATION USING EXTENDED RIGHT LOBE GRAFTS

Objective The authors report their experience with living donor liver transplantation (LDLT) using extended right lobe grafts for adult pati ents under high-urgency situations. Summary Background Data The effica cy of LDLT in the treatment of children has been established. The majo r limitation of adult-to-adult LDLT is the adequacy of the graft size. A left lobe graft from a relatively small volunteer donor will not me et the metabolic demand of a larger recipient. Methods From May 1996 t o November 1996, seven LDLTs, using extended right lobe grafts, were p erformed under high-urgency situations. All recipients were in intensi ve care units before transplantation with five having acute renal fail ure, three on mechanical ventilation, and all with hepatic encephalopa thy. The median body weight for the donors and recipients was 58 kg (r ange, 41-84 kg) and 65 kg (range, 53-90 kg), respectively. The body we ights of four donors were less than those of the corresponding recipie nts, and the lowest donor-to-recipient body weight ratio was 0.62:1. T he extended right lobe graft was chosen because the left lobe volume w as <40% of the ideal liver mass of the recipient. Results Median blood loss for the donors was 900 mL (range, 700-1600 mL) and hospital stay was 19 days (range, 8-22 days). Homologous blood transfusion was not required. Two donors had complications (one incisional hernia and one bile duct stricture) requiring reoperation after discharge. All were w ell with normal liver function 5 to 10 months after surgery. The graft weight ranged from 490 g to 1140 g. All grafts showed immediate funct ion with normalization of prothrombin time and recovery of conscious s tate of the recipients. There was no vascular complication, but six re cipients required reoperation. One recipient died of systemic candidia sis 16 days after transplantation and 6 (86%) were alive with the orig inal graft at a median follow-up of 6.5 months (range, 5-10 months).Co nclusions When performed by a team with experience in hepatectomy and transplantation, LDLT, using an extended right lobe graft, can achieve superior results. The technique extends the success of LDLT from pedi atric recipients to adult recipients and opens a new donor pool for ad ults to receive a timely graft of adequate function.