Living-donor liver transplantation: Right versus left

Area of Science:

• Hepatobiliary surgery
• Transplant surgery
• Surgical anatomy

Background:

• Graft selection in living-donor liver transplantation (LDLT) and deceased-donor liver transplantation (DDLT) presents a choice between right and left liver grafts.
• Historically, the right liver was favored due to its larger volume and central vascular structures, including the inferior vena cava.
• Current trends prioritize donor safety, often leading to the decision of whether to include the middle hepatic vein (MHV) with the right graft or leave it with the remnant liver.

Discussion:

• The critical importance of preserving vascular inflow and outflow for both the graft and the remaining liver cannot be overstated.
• Procurement decisions must balance graft volume, anatomical considerations, and the need for reconstructable vascular and biliary elements.
• The management of the middle hepatic vein (MHV) is a key consideration, with practices varying among transplant centers.

Key Insights:

• Optimal liver graft procurement necessitates meticulous preoperative planning, typically utilizing 3D-computed tomography.
• Assessment of graft volume and potential for congestion is crucial for successful outcomes.
• Ensuring reconstructable portal veins, hepatic arteries, hepatic veins, and bile ducts is paramount for any graft type.

Outlook:

• Future advancements may refine graft selection criteria and surgical techniques in liver transplantation.
• Standardization of MHV management could improve consistency in LDLT outcomes.
• Continued research into 3D imaging and surgical planning will enhance graft viability and patient safety.