Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2017; 23(23): 4270-4277
Published online Jun 21, 2017. doi: 10.3748/wjg.v23.i23.4270
Outcomes of right-lobe and left-lobe living-donor liver transplantations using small-for-size grafts
Wong Hoi She, Kenneth SH Chok, James YY Fung, Albert CY Chan, Chung Mau Lo
Wong Hoi She, Department of Surgery, the University of Hong Kong, Hong Kong, China
Kenneth SH Chok, Albert CY Chan, Chung Mau Lo, Department of Surgery and State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
James YY Fung, Department of Medicine and State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
Author contributions: She WH and Chok KSH contributed to study conception and design, and drafted the manuscript; She WH contributed to data acquisition, analysis and interpretation; Fung JYY, Chan ACY and Lo CM revised the article critically for important content; Lo CM gave final approval of the revised version; all authors approved the submitted version of the paper.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kenneth SH Chok, MS, Associate Professor, Department of Surgery, the University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. kennethchok@gmail.com
Telephone: +852-22553025 Fax: +852-28165284
Received: January 24, 2017
Peer-review started: February 1, 2017
First decision: February 23, 2017
Revised: March 9, 2017
Accepted: May 19, 2017
Article in press: May 19, 2017
Published online: June 21, 2017
Processing time: 146 Days and 18.9 Hours
Abstract
AIM

To analyze the outcomes of living-donor liver transplantation (LDLT) using left-lobe (LL) or right-lobe (RL) small-for-size (SFS) grafts.

METHODS

Prospectively collected data of adult patients who underwent LDLT at our hospital in the period from January 2003 to December 2013 were reviewed. The patients were divided into the RL-LDLT group and the LL-LDLT group. The two groups were compared in terms of short- and long-term outcomes, including incidence of postoperative complication, graft function, graft survival, and patient survival. A SFS graft was defined as a graft with a ratio of graft weight (GW) to recipient standard liver volume (RSLV) (GW/RSLV) of < 50%. The Urata formula was used to estimate RSLV.

RESULTS

Totally 218 patients were included for analysis, with 199 patients in the RL-LDLT group and 19 patients in the LL-LDLT group. The two groups were similar in terms of age (median, 53 years in the RL-LDLT group and 52 years in the LL-LDLT group, P = 0.997) but had significantly different ratios of men to women (165:34 in the RL-LDLT group and 8:11 in the LL-LDLT group, P < 0.0001). The two groups were also significantly different in GW (P < 0.0001), GW/RSLV (P < 0.0001), and graft cold ischemic time (P = 0.007). When it comes to postoperative complication, the groups were comparable (P = 0.105). Five patients died in hospital, 4 (2%) in the RL-LDLT group and 1 (5.3%) in the LL-LDLT group (P = 0.918). There were 38 graft losses, 33 (16.6%) in the RL-LDLT group and 5 (26.3%) in the LL-LDLT group (P = 0.452). The 5-year graft survival rate was significantly better in the RL-LDLT group (95.2% vs 89.5%, P = 0.049). The two groups had similar 5-year patient survival rates (RL-LDLT: 86.8%, LL-LDLT: 89.5%, P = 0.476).

CONCLUSION

The use of SFS graft in LDLT requires careful tailor-made surgical planning and meticulous operation. LL-LDLT can be a good alternative to RL-LDLT with similar recipient outcomes but a lower donor risk. Further research into different patient conditions is needed in order to validate the use of LL graft.

Keywords: Small for size liver graft; Right lobe graft; Left lobe graft; Living donor liver transplantation

Core tip: Liver transplant has become an established treatment for liver failure. The use of living-donor liver graft is one important strategy to expand the donor pool. The use of left lobe graft remains controversial due to the potential problem of small-for-size syndrome. This study illustrates that the use of left lobe graft can produce outcomes similar to right lobe graft. However, the study contains selection bias since most of the recipients of left lobe grafts had relatively lower Model for End-stage Liver Disease scores and were women, who are lighter in weight. Therefore, further study should focus on the establishment of criteria for the use of left lobe graft to allow safe transplant.