Microcirculatory changes in right lobe grafts in living-donor liver transplantation: A near-infrared spectrometry study

Background. A continuing shortage of cadaveric liver even for adult patient s has motivated not a few centers to proceed to living-donor liver transpla ntation using right lobe grafts. One of controversies is potential congesti on in the graft anterior segment by the deprivation of the middle hepatic v ein. Methods. Hepatic tissue oxygenation and hemoglobin concentration were inves tigated with a near-infrared spectroscopy in the course of harvesting and i mplantation in living-donor liver transplantation. Twenty adult recipients of right lobe graft were involved in the study. The aim of the analysis was to detect tissue congestion or ischemia. Results. No significant change in mean hepatic tissue oxygenation and hemog lobin was noted in the right lobe during donor operation even after hepatic parenchymal transection, although some trend for relative congestion, i.e. , increased tissue hemoglobin, compared with the left lobe was observed. Af ter graft reperfusion in the recipient, both mean hepatic tissue oxygen sat uration and hemoglobin decreased significantly in the anterior segment, whi ch was accompanied by increased heterogeneity of tissue hemoglobin and oxyg enation. Increased heterogeneity of oxygenation and decreased tissue hemogl obin were observed also in the posterior segment. Conclusions. The anterior segment in right lobe living-donor liver transpla ntation is sensitive to ischemia, rather than congestion, at least in the i mmediate phase after graft reperfusion. The anterior segment seems to be al so more prone to circulatory disturbance than the other part of the graft.