Safety evaluation of donors when performing modified extended right lobe hepatectomy in ALDLT

To evaluate the safety of the donor after donation of right lobe with middle hepatic vein (MHV) in adult-to-adult living donor liver transplantation (ALDLT).

From Jun 2006 to Dec 2008, 32 patients underwent ALDLT using right lobe liver grafts in our center according to our own individualized selection criteria of the right lobe graft with MHV, in which 22 donors received right lobe graft without MHV (Group 1, n = 22) and 10 donors received right lobe graft with MHV (Group 2, n = 10). Besides protecting the venous return of segment IVb, we reserved the tissue of segment IV as much as possible. We compared the two groups in terms of their intraoperative data, postoperative recovery, complication, regeneration of the remnant liver and spleen hypersplenism.

There was no significant difference between two groups in ages, steatosis of the graft, remnant liver volume, etc., nor the operation time and blood loss. Besides the body weights and whole-liver volumes which were greater in group 1 than in group 2, the graft weights (GW) were proximate in two groups, and there were no significant differences in GW/SLV and GRWR as well. Donors in both group 1 and group 2 recovered with satisfaction, and the serum ALT from group 2 recovers even faster than that from group 1; Three months after operations, the remnant livers from group 2 appeared to have a good regeneration as well as the spleen, though there was only one case developing temporary hypersplenism. There was no statistical difference in the rate of complications (p = 0.79).

It is more accessible to obtain a larger graft with modified extended right lobe hepatectomy. Congestion in segment IV might help the remnant liver to regenerate. For donors with more than 35% livers reserved without obvious hepatic steatosis, it is safe to perform right lobe hepatectomy with MHV.