Regeneration and function of hemiliver graft: right versus left

A right liver graft used almost routinely for adult living donor liver transplantation (LDLT), is associated with a higher incidence of morbidity and mortality in the donor. We compared volume regeneration and graft function between left and right liver grafts to examine the feasibility of using left liver grafts.

The left liver was considered acceptable as a graft when it was estimated to be over 40% of the recipient standard liver volume. Otherwise, right liver harvesting was used, provided the estimated right liver volume was less than 70% of the donor's standard liver volume. Graft volume on computed tomography and the results of liver function tests 1, 3, and 12 months after LDLT were compared between recipients with left (n = 76) and right (n = 83) grafts. Possible factors influencing graft regeneration were evaluated by multivariate analysis.

A higher regeneration rate in the left liver graft group resulted in the same ratio of graft to standard liver volume as in the right liver graft group (88% vs 87%) 1 year after LDLT. Liver function tests and 5-year survival rates were comparable between the 2 groups. An episode of acute rejection was a predictive factor for impaired graft regeneration 1 month after LDLT. The initial ratio of graft volume to standard liver volume was an independent factor for regeneration 1 year after LDLT.

A properly evaluated left liver graft can be used as safely as a right liver graft in adult-to-adult LDLT. The findings of the present study justify LDLT with a left liver graft under specific selection criteria and may be preferred to a right liver graft.