Right posterior segment graft in living donor liver transplantation

Living donor liver transplantation (LDLT) is widely performed for end-stage liver disease. Liver volume is important for donor safety and recipient survival. In adult-to-adult LDLT, left lobe graft is frequently insufficient for the recipient, while right lobe graft carries a higher donor risk. The right posterior segment graft (RPSG) was introduced to increase donor selection options. However, only a few institutions have reported LDLT with an RPSG.

In total, 587 adult recipients underwent LDLT at Kyoto University Hospital from 2001 to 2011. Here, we retrospectively report 14 LDLT with RPSG. All donors underwent volumetric analyses and detailed investigation of the hepatic vein (HV), portal vein (PV), hepatic artery (HA) and biliary duct (BD). Anatomical anomalies were detected in four donors' BD. The mean Model for End-Stage Liver Disease score was 22.6 ± 12.4 points. ABO blood groups were characterized as incompatible in three cases. The mean graft-to-recipient weight ratio was 0.897 ± 0.203.

Donors' postoperative courses were uneventful. To adjust diameters and lengths between grafts and recipients, dual anastomoses for PV reconstruction and graft interpositions for PV and HA reconstruction were required in one case each. HA thrombosis occurred in two cases and PV thrombosis in one. Biliary complications occurred in two cases. Though there was no significant difference in survival following RPSG versus other grafts, critical complications were observed in recipients.

The RPSG is a useful option in LDLT. However, careful consideration is required for RPSG harvest and LDLT performance, both before and during surgery.