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Live Liver Donors: Is Right Still Right?
Ashwin Rammohan1,2, Mettu S Reddy3,4, Gomathy Narasimhan3,4
1The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, 600044, India. ashwinrammohan@gmail.com.
World Journal of Surgery
|March 7, 2020
Summary
Live donor liver transplantation (LDLT) outcomes are comparable between right and left lobe donors. A strict protocol ensures donor safety, regardless of the liver lobe utilized for transplantation.
Area of Science:
- Hepatology
- Transplant Surgery
- Organ Donation
Background:
- Conventional wisdom favors left lobe donation in live donor liver transplantation (LDLT) due to concerns about larger hepatectomy risks.
- Donor safety is paramount in LDLT, influencing the preference for left lobe grafts to achieve double equipoise.
- Emerging data suggests right lobe donation may also be safe in experienced centers.
Purpose of the Study:
- To compare donor outcomes between right lobe and left lobe liver donations in LDLT.
- To evaluate the safety and efficacy of right lobe versus left lobe grafts in a center with extensive LDLT experience.
Main Methods:
- A retrospective review of a prospectively collected database of right and left lobe liver donors.
- Comparison of preoperative demographics, operative, and postoperative outcomes between donor groups.
- Analysis included 904 liver transplantations between August 2009 and July 2017.
Main Results:
- Right lobe donors had significantly different graft-to-recipient weight ratio (GRWR) and functional liver remnant compared to left lobe donors.
- Higher end portal pressure, peak bilirubin, and day 5 bilirubin were observed in right lobe donors.
- No significant differences were found in blood loss, surgery duration, peak lactate, overall complications, or serious complications (Clavien-Dindo > III) between right and left lobe donors.
Conclusions:
- Biochemical differences exist between right and left lobe donors, but overall donor outcomes are comparable.
- A strict, protocol-based donor selection process ensures comparable outcomes for both right and left lobe donations in LDLT.
- This study challenges the conventional preference for left lobe donation by demonstrating the safety of right lobe donation in experienced centers.
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