Single-center analysis of the first 40 adult-to-adult living donor liver transplants using the right lobe

The first adult-to-adult living donor liver transplant using the right hepa tic lobe in the United States was performed only 2 years ago. Although init ial reports were encouraging, continuous review of the results and appropri ate modifications in patient management will be necessary to minimize donor risk and optimize recipient outcome, The results of 40 such transplantatio ns were analyzed and are summarized. Recipients were listed for transplanta tion according to the usual criteria. Living donors were not considered for United Network for Organ Sharing status IIA patients after the initial 22 patients. Donor evaluation followed a rigid protocol. A graft-to-recipient body weight ratio of at least 0.8% was the minimum required throughout most of the study. The surgical procedures were similar, except the plane of tr ansection was modified to better accommodate donor biliary anatomy, and uni form stenting of bile ducts was practiced after the first 10 transplants, I mmunosuppression consisted of tacrolimus, mycophenolate mofetil, and a pred nisone taper. The target tacrolimus level was decreased and mycophenolate w as withdrawn more rapidly in the second half of the study because of the ab sence of acute cellular rejection. Donor morbidity has been Limited to mino r complications, and transplant recipient biliary complications decreased f rom 35% to 0%, Acute cellular rejection has not been observed despite less aggressive immunosuppression, and septic complications decreased dramatical ly. There have been no recipient deaths since these changes were instituted . Right lobectomy can be performed safely in the donor population. Recipien t biliary complications can be minimized with stenting. Less aggressive imm unosuppression is well tolerated and minimizes septic complications and att ributable mortality.