Right hepatic lobectomy as a liver graft-saving procedure

Retransplantation is common after liver transplantation (LT). However, in t he present era of organ shortages, every attempt to save the liver graft sh ould be performed before considering retransplantation. We report our exper ience with right hepatic lobectomy (RHL) for liver graft salvage. In a retr ospective series of 180 adult LTs, 4 patients underwent RHL (Couinaud's seg ments V, VI, VII, VIII) in the post-LT period. In all cases, the procedure was performed without Pringle's maneuver or mobilization of the left liver lobe to preserve its vascularization. Three liver graft recipients develope d intrahepatic biliary strictures, mainly localized to the right lobe of th e graft, and RHL was performed 14, 75, and 78 months after LT. These patien ts were alive at last follow-up without further episodes of cholangitis or retransplantation (mean followup, 38 months). The fourth patient developed early post-LT right liver necrosis with a functioning hepatic artery and un derwent right lobectomy 48 hours after LT. He later developed cholangitis s econdary to late hepatic artery thrombosis, requiring retransplantation aft er 18 months. We conclude that RHL can be considered a graft-saving option in selected liver transplant recipients with localized biliary strictures, with excellent patient and graft survival.