Display options
Cite
Sudhindran S, Menon RN, Balakrishnan D. Challenges and Outcome of Left-lobe Liver Transplants in Adult Living Donor Liver Transplants. J Clin Exp Hepatol. 2012;2(2):181-7doi: 10.1016/S0973-6883(12)60106-6.
Sudhindran, S., Menon, R. N., & Balakrishnan, D. (2012). Challenges and Outcome of Left-lobe Liver Transplants in Adult Living Donor Liver Transplants. Journal of clinical and experimental hepatology, 2(2), 181-7. https://doi.org/10.1016/S0973-6883(12)60106-6
Sudhindran, S, et al. "Challenges and Outcome of Left-lobe Liver Transplants in Adult Living Donor Liver Transplants." Journal of clinical and experimental hepatology vol. 2,2 (2012): 181-7. doi: https://doi.org/10.1016/S0973-6883(12)60106-6
Sudhindran S, Menon RN, Balakrishnan D. Challenges and Outcome of Left-lobe Liver Transplants in Adult Living Donor Liver Transplants. J Clin Exp Hepatol. 2012 Jun;2(2):181-7. doi: 10.1016/S0973-6883(12)60106-6. Epub 2012 Jul 21. PMID: 25755426; PMCID: PMC3940376.
Copy Download .nbib Format: NLM
Share it on

J Clin Exp Hepatol. 2012 Jun;2(2):181-7. doi: 10.1016/S0973-6883(12)60106-6. Epub 2012 Jul 21.

Challenges and Outcome of Left-lobe Liver Transplants in Adult Living Donor Liver Transplants.

Journal of clinical and experimental hepatology

S Sudhindran, Ramachandran N Menon, Dinesh Balakrishnan

Affiliations

  1. Department of Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala - 682041.

PMID: 25755426 PMCID: PMC3940376 DOI: 10.1016/S0973-6883(12)60106-6

Abstract

Adult-to-adult living donor liver transplant (LDLT) frequently depend on using the right-lobes of the donor for obtaining adequate graft-to-recipient weight ratio (GRWR) of over 0.8% in the recipient. However, left-lobes remain an important option in adults, since the morbidity in the donor is considerably less with left donor hepatectomy when compared with right side liver resection. Further benefits of left-lobes in LDLT include more predictable anatomy of the left hepatic duct and left portal vein, which are usually long and single resulting in easier anastomosis in the recipient. Likewise, left-lobe grafts are easier to implant with an excellent venous outflow through the combined orifice of left and middle hepatic vein, as opposed to the complex hepatic vein reconstruction required in right-lobe grafts. However, left hepatic artery is often multiple unlike the right hepatic artery. The holy grail of left-lobe transplants is avoidance of small for size syndrome (SFSS) in the recipients. The strategies for overcoming SFSS currently depend on circumventing portal hyperperfusion in the graft. Measurement of portal pressure and modulating it if high, by splenic artery ligation, splenectomy, or hemiportocaval shunts are proving successful in avoiding SFSS. The future aim in adult LDLT should be to use the left-lobe as much as possible for the benefit of the donor at the same time avoiding SFSS even at very low GRWR for the benefit of the recipient.

Keywords: Advantages; GRWR; GRWR, graft-to-recipient weight ratio; ITU, instensive therapy unit; IVC, inferior vena cava; LDLT, living donor liver transplantation; LHV, left hepatic vein; MHV, middle hepatic vein; RHV, right hepatic vein; SFSS, small for size syndrome; disadvantages; graft-to-recipient weight ratio; hemiportocaval shunt; left lobe; living donor liver transplants; portal hyper perfusion; results; small for size syndrome; splenectomy; splenic artery ligation

References

  1. Transplantation. 2003 Apr 27;75(8):1313-7 - PubMed
  2. N Engl J Med. 2003 Feb 27;348(9):818-25 - PubMed
  3. Am J Transplant. 2012 May;12(5):1208-17 - PubMed
  4. Radiology. 1992 Jul;184(1):157-8 - PubMed
  5. Am J Transplant. 2012 Jul;12(7):1877-85 - PubMed
  6. Liver Transpl. 2004 Jun;10(6):807-10 - PubMed
  7. Transplantation. 1999 Jan 27;67(2):321-7 - PubMed
  8. Liver Transpl. 2006 Jun;12(6):920-7 - PubMed
  9. Gastroenterology. 2012 Feb;142(2):273-80 - PubMed
  10. Transpl Int. 2009 Aug;22(8):837-44 - PubMed
  11. World J Gastroenterol. 2005 Nov 28;11(44):6954-9 - PubMed
  12. Liver Transpl. 2002 May;8(5):495-9 - PubMed
  13. Hepatogastroenterology. 2002 Nov-Dec;49(48):1652-5 - PubMed
  14. Lancet. 1989 Aug 26;2(8661):497 - PubMed
  15. Transplant Proc. 2001 Nov-Dec;33(7-8):3461-3 - PubMed
  16. Gastroenterology. 2008 Aug;135(2):468-76 - PubMed
  17. Am J Transplant. 2005 Nov;5(11):2605-10 - PubMed
  18. J Am Coll Surg. 2000 May;190(5):635-8 - PubMed
  19. Liver Transpl. 2007 Jan;13(1):91-8 - PubMed
  20. Transplant Proc. 2004 Oct;36(8):2277-8 - PubMed
  21. Am J Transplant. 2007 Oct;7(10):2344-9 - PubMed
  22. Transplant Proc. 2004 Oct;36(8):2234-6 - PubMed
  23. Transplantation. 2010 Dec 15;90(11):1200-3 - PubMed
  24. N Engl J Med. 1990 May 24;322(21):1505-7 - PubMed
  25. Lancet. 2002 Feb 2;359(9304):406-7 - PubMed
  26. Liver Transpl. 2006 Oct;12(10):1485-8 - PubMed
  27. Liver Transpl. 2008 Aug;14(8):1180-4 - PubMed
  28. Am J Transplant. 2005 Jun;5(6):1397-404 - PubMed
  29. Lancet. 1994 May 14;343(8907):1233-4 - PubMed
  30. Transplantation. 2010 May 27;89(10):1276-82 - PubMed
  31. Liver Transpl. 2006 Sep;12(9):1326-36 - PubMed
  32. Liver Transpl. 2010 Jun;16(6):718-28 - PubMed
  33. Liver Transpl. 2010 May;16(5):649-57 - PubMed
  34. Liver Transpl. 2004 Feb;10(2):253-63 - PubMed
  35. Am J Transplant. 2008 Apr;8(4):847-53 - PubMed
  36. Liver Transpl. 2003 Jan;9(1):79-86 - PubMed
  37. Liver Transpl. 2003 Jun;9(6):626-8 - PubMed
  38. Clin Transplant. 2011 Jul-Aug;25(4):625-32 - PubMed
  39. Liver Transpl. 2000 Nov;6(6):710-4 - PubMed
  40. Pediatr Transplant. 2010 Nov;14(7):870-8 - PubMed

Publication Types