Clinical

Right lobe living donor liver transplants compare favorably with cadaveric livers

Last Updated: 2006-04-05 9:33:01 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In a prospective study of liver transplantations at a hospital in Hong Kong, right lobe live donor liver transplantation was as successful as cadaveric whole-graft liver transplantation in adults.

The only difference that the clinicians observed was a higher incidence of biliary stricture associated with right lobe transplants, but this complication was amenable to treatment and did not affect graft or patient survival.

Retrospective studies have suggested that graft survival with right lobe live donor liver transplantation was inferior to cadaveric liver transplantation, which was blamed on small graft size. However, Dr. Sheung Tat Fan and his associates at the University of Hong Kong point out that a prospective comparison of the two procedures within a single center has not been reported.

They therefore compared outcomes for adults treated between 2000 and 2004 at Queen Mary Hospital. Included were 124 patients who underwent right lobe live donor liver transplantation and 56 who underwent cadaveric whole-graft liver transplantation.

According to the investigators' report in the March Annals of Surgery, median preoperative waiting times were 14 days and 237 days, respectively.

Median length of ICU stay, postoperative hospital stay, and hospital mortality did not differ significantly between groups.

After a median follow-up of 27 months in the living donor group and 25 months in the cadaver donor group, corresponding patient survival was 90% and 84%. During the same period, the mortality rate of patients on the wait list was 43%.

As noted, the only significant difference between groups was the incidence of late biliary stricture -- 25% in the living donor group and 5% in the cadaveric donor group (p = 0.002). Strictures were treated successfully with endoscopic stenting and balloon dilatation, percutaneous biliary drainage and balloon dilatation, or surgical reconstruction.

Dr. Fan's team also points out that none of the donors died or required any transfusions. There were four major complications, including two cases of cholestasis that resolved spontaneously, one biliary stricture that required endoscopic stenting and dilatation, and an intraoperative portal vein thrombosis that was treated during the same operation.

Dr. Fan's group comments that good venous drainage of the anterior section of the right lobe liver graft is required for satisfactory postoperative liver function. "We adopted a policy of routine inclusion of the middle hepatic vein in the right lobe liver grafts, and we have observed satisfactory operative outcomes," they report.

"Right lobe liver grafts should not be considered as marginal grafts," they conclude.

Ann Surg 2006;243:404-410.