Right lobe donor hepatectomy: is it safe? A retrospective study

Area of Science:

• Hepatobiliary Surgery
• Transplant Surgery
• Donor Safety

Background:

• Living donor liver transplantation (LDLT) prioritizes donor safety.
• Small for size syndrome in recipients after left lobe donation prompted the use of right lobe (RL) grafts.
• Right lobe LDLT has become a crucial alternative for expanding donor options.

Purpose of the Study:

• To evaluate the safety of right lobe donor hepatectomies.
• To compare outcomes of right lobe donations with left lobe (LL) and left lateral segment (LLS) donations.
• To assess the impact of graft-to-recipient weight ratio (GRWR) on recipient outcomes.

Main Methods:

• A consecutive cohort of 726 living liver donors from January 2011 to January 2014 were analyzed.
• Donors were categorized into right lobe (n=641), left lobe (n=36), and left lateral segment (n=49) groups.
• Donor complications were graded using the Clavien classification system.

Main Results:

• The overall complication rate was 22.3%, with most being minor (Clavien grade I and II).
• Major complications (Clavien grade III-V) occurred in 4.2% of donors and were comparable across RL, LL, and LLS groups (P=0.89).
• Bile leak occurred in 2.7% of donors, with most managed conservatively.

Conclusions:

• Morbidity after right lobe donation is similar to left lobe donation in experienced centers.
• Right lobe LDLT offers comparable 1-year recipient outcomes to left lobe donation when adequate GRWR is achieved.
• Donor safety is paramount and achievable with right lobe hepatectomy in LDLT.