Donor safety and remnant liver volume in living donor liver transplantation.

AIM To evaluate the relationship between donor safety and remnant liver volume in right lobe living donor liver transplantation (LDLT). METHODS From July 2001 to January 2009, our liver transplant centers carried out 197 LDLTs. The clinical data from 151 cases of adult right lobe living donors (not including the middle hepatic vein) were analyzed. The conditions of the three groups of donors were well matched in terms of the studied parameters. The donors' preoperative data, intraoperative and postoperative data were calculated for the three groups: Group 1 remnant liver volume (RLV) < 35%, group 2 RLV 36%-40%, and group 3 RLV > 40%. Comparisons included the different remnant liver volumes on postoperative liver function recovery and the impact of systemic conditions. Correlations between remnant liver volume and post-operative complications were also analyzed. RESULTS The donors' anthroposomatology data, operation time, and preoperative donor blood test indicators were calculated for the three groups. No significant differences were observed between the donors' gender, age, height, weight, and operation time. According to the Chengdu standard liver volume formula, the total liver volume of group 1 was 1072.88 ± 131.06 mL, group 2 was 1043.84 ± 97.11 mL, and group 3 was 1065.33 ± 136.02 mL. The three groups showed no statistically significant differences. When the volume of the remnant liver was less than 35% of the total liver volume, the volume of the remnant had a significant effect on the recovery of liver function and intensive care unit time. In addition, the occurrence of complications was closely related to the remnant liver volume. When the volume of the remnant liver was more than 35% of the total liver volume, the remnant volume change had no significant effect on donor recovery. CONCLUSION To ensure donor safety, the remnant liver volume should be greater than the standard liver volume (35%) in right lobe living donor liver transplantation.

[1]  J. Trotter,et al.  Documented deaths of hepatic lobe donors for living donor liver transplantation , 2006, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[2]  Q. Lu,et al.  Hepatic venous outflow reconstruction in right lobe graft without middle hepatic vein , 2007, Hepatology research : the official journal of the Japan Society of Hepatology.

[3]  J. Roberts,et al.  Long‐term complications of living donor liver transplantation , 2000, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[4]  N. Demartines,et al.  Classification of Surgical Complications: A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey , 2004, Annals of Surgery.

[5]  S. Kawasaki,et al.  Standard liver volume in adults. , 2000, Transplantation proceedings.

[6]  T. Wen,et al.  Evaluation of standard liver volume formulae for Chinese adults. , 2009, World journal of gastroenterology.

[7]  T. Starzl,et al.  Complications of right lobe living donor liver transplantation. , 2009, Journal of hepatology.

[8]  L. Okawa,et al.  Donor Complications Including the Report of One Death in Right-Lobe Living-Donor Liver Transplantation , 2007, Digestive Surgery.

[9]  Lunan Yan,et al.  Using the Clavien grading system to classify the complications of right hepatectomy in living donors. , 2009, Transplantation proceedings.

[10]  A. Jain,et al.  Living‐Donor Liver Transplantation in the United States: Identifying Donors at Risk for Perioperative Complications , 2007, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[11]  K. Olthoff.  Hepatic regeneration in living donor liver transplantation , 2003, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[12]  Y. Maehara,et al.  Donor Risk in Adult-to-Adult Living Donor Liver Transplantation: Impact of Left Lobe Graft , 2009, Transplantation.

[13]  R. Killi,et al.  Donor safety and remnant liver volume in living donor liver transplantation , 2008, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[14]  S. K. Lee,et al.  Adult-to-adult living donor liver transplantation at the Asan Medical Center, Korea. , 2002, Asian journal of surgery.

[15]  J. Joh,et al.  Outcome of donors with a remnant liver volume of less than 35% after right hepatectomy , 2006, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[16]  K. Sung,et al.  Living donor liver transplantation: complications in donors and interventional management. , 2004, Radiology.

[17]  S. Kawasaki,et al.  Calculation of child and adult standard liver volume for liver transplantation , 1995, Hepatology.

[18]  Roland Materne,et al.  Body surface area and body weight predict total liver volume in Western adults , 2002, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[19]  Jiayin Yang,et al.  Measures for increasing the safety of donors in living donor liver transplantation using right lobe grafts. , 2007, Hepatobiliary & pancreatic diseases international : HBPD INT.

[20]  G. Maddern,et al.  Living donor liver transplantation—Adult donor outcomes: A systematic review , 2006, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[21]  M. Zand,et al.  Minimizing Morbidity of Organ Donation: Analysis of Factors for Perioperative Complications After Living-Donor Nephrectomy in the United States , 2008, Transplantation.

[22]  K Püschel,et al.  Standard liver volume in the Caucasian population. , 1999, Liver transplantation and surgery : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[23]  Koichi Tanaka,et al.  "Small-for-size graft" and "small-for-size syndrome" in living donor liver transplantation. , 2004, Yonsei medical journal.

[24]  S. Fan,et al.  A Decade of Right Liver Adult-to-Adult Living Donor Liver Transplantation: The Recipient Mid-term Outcomes , 2008, Annals of surgery.