Left liver graft in adult-to-adult living donor liver transplantation with an optimal portal flow modulation strategy to overcome the small-for-size syndrome-A retrospective cohort study
- Authors
- Jo, Hye-Sung; Yu, Young-Dong; Choi, Yoo Jin; Kim, Dong-Sik
- Issue Date
- Oct-2022
- Publisher
- Elsevier
- Keywords
- Liver transplantation; Left liver graft; Small-for-size syndrome; Portal modulation; Treatment outcome
- Citation
- International Journal of Surgery, v.106
- Indexed
- SCIE
SCOPUS
- Journal Title
- International Journal of Surgery
- Volume
- 106
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/61793
- DOI
- 10.1016/j.ijsu.2022.106953
- ISSN
- 1743-9191
1743-9159
- Abstract
- Background
Adult-to-adult living donor liver transplantation (LDLT) is a notable type of liver transplantation. Several centers prefer the right liver graft (RLG) over the left liver graft (LLG) for better recovery of recipients. We compared the outcomes of donors and recipients between LDLT using LLGs and RLGs.
Materials and methods
The study cohort comprised of 25 patients in the LLG group and 93 in the RLG group. When both hemiliver grafts met the selection criteria, an LLG was preferred. When portal flow (≥300 ml/min/100gLW) and hepatic venous pressure gradient (≥10 mmHg) were increased, intraoperative splenic artery ligation was performed for portal modulation. Postoperatively, somatostatin was administered when small-for-size syndrome (SFSS) was highly suspected.
Results
The graft-to-recipient weight ratio was lower in the LLG group than in the RLG group. There was no significant complication above Clavien–Dindo grade IIIA in donors. Regarding recipient outcomes, SFSS occurred in four (16.0%) patients in the LLG group and three (3.2%) in the RLG group (P = 0.036). Splenic artery ligation was frequently performed in the LLG group than the RLG group (5 [20.0%] vs. 12 [12.9%], P = 0.035) and 5 patients received intravenous continuous somatostatin for 7 (5–12) days. SFSS-related hospital mortality did not occur. There was no significant difference in the short-term and long-term outcomes between the groups.
Conclusion
This study demonstrates the comparable outcomes of donors and recipients between the LLG and RLG groups although with a higher risk of SFSS that needs high experience to avoid severe complications and graft loss. We expect LLG to be used more actively in adult-to-adult LDLT with portal flow modulation strategies to overcome fatal SFSS.
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Collections - 2. Clinical Science > Department of Hepato-Biliary-Pancreatic Surgery > 1. Journal Articles
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