Selection and outcome of living donors for adult to adult right lobe transplantation

Background. The shortage of cadaveric livers has sparked an interest in adu lt-to-adult living donor transplantation. Right lobe donor hepatectomy is f requently required to obtain a graft of adequate size for adult recipients. Careful donor selection is necessary to minimize complications and assure a functional graft. Methods. A four-step evaluation protocol was used for donor selection and s atisfactory results of all tests in each step were required before proceedi ng to the next. Donors were selected based on a battery of laboratory studi es chosen to exclude unrecognized infection, liver disease, metabolic disor ders, and conditions representing undue surgical risk. Imaging studies incl uded ultrasonography, angiography, magnetic resonance imaging, and intraope rative cholangiography and ultrasonography. The information obtained from l iver biopsy was used to correct the estimated graft mass for the degree of steatosis, Results. From March 1998 to August 1999, 126 candidates were evaluated for living donation. A total of 35 underwent donor right lobectomy with no sign ificant complications, Forty percent of all donors that came to surgery wer e genetically unrelated to the recipient. A total of 69% of those evaluated were excluded. ABO incompatibility was the primary reason for exclusion af ter the first step (71%) and the presence of steatosis yielding an inadequa te estimated graft mass after the second step (20%). Conclusions. Donor selection limits the application of living donor liver t ransplantation in the adult population. Unrelated individuals increase the size of the donor pool. Right lobe hepatectomy can be performed safely in h ealthy adult liver donors. Preoperative liver biopsy is an essential part o f the evaluation protocol, particularly when the estimated graft mass is ma rginal.