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Published on: March 7, 2013
Right hepatic lobectomy as a liver graft-saving procedure
1Department of Liver Surgery and Transplantation, University of Liège, University Hospital Sart Tilman, B-4000 Liège, Belgium.
Summary
Right hepatic lobectomy (RHL) can salvage liver grafts in select liver transplant (LT) patients with localized biliary strictures. This graft-saving procedure offers excellent patient and graft survival, potentially avoiding retransplantation.
Area of Science:
- Hepatobiliary Surgery
- Transplant Surgery
- Gastroenterology
Background:
- Liver retransplantation is frequently required after liver transplantation (LT).
- Organ shortages necessitate strategies to preserve existing liver grafts.
- Right hepatic lobectomy (RHL) is explored as a graft salvage technique.
Purpose of the Study:
- To evaluate the efficacy of RHL for liver graft salvage in adult LT recipients.
- To assess patient and graft survival after RHL for post-LT complications.
- To determine if RHL can prevent retransplantation.
Main Methods:
- Retrospective review of 180 adult LT cases.
- Identified 4 patients who underwent RHL for graft salvage post-LT.
- RHL performed on Couinaud's segments V-VIII without Pringle's maneuver or left lobe mobilization.
Main Results:
- Three patients with intrahepatic biliary strictures underwent RHL months after LT and survived without retransplantation (mean follow-up 38 months).
- One patient with early post-LT right liver necrosis underwent RHL but later required retransplantation due to hepatic artery thrombosis.
- Successful graft salvage was achieved in selected cases, avoiding retransplantation.
Conclusions:
- RHL is a viable graft-saving option for liver transplant recipients with localized biliary strictures.
- The procedure can lead to excellent patient and graft survival.
- Careful patient selection is crucial for successful outcomes with RHL in LT.
