Head-to-head comparison of the right and left liver graft in adult-to-adult live donor liver transplantation

Abstract

The right liver graft has become the workhorse of adult-to-adult live donorliver transplantation (ALDLT) by virtue of size. Favorable recipientoutcomes of left liver ALDLT have also been reported. The surgicaloutcomes of ALDLT using right and left liver grafts of the comparable sizeall including the middle hepatic vein are yet unknown.Method and PatientsFrom July 1994 to July 2005, 16 consecutive left liver ALDLT wereperformed. Among the 207 right liver ALDLT performed over the sameperiod, 29 cases of comparable graft weight to standard liver volume (byUrata formula) ratio were identified for comparison. Donors, recipients,and graft data collected prospectively were retrieved from the livertransplant database.ResultsAge of donors and of recipients were comparable between the two groups.Right liver donors were predominantly female (M:F 2:27) and left liverdonors mainly male (M:F 14:2) (P = 0.000). The right liver recipients werepredominantly male (M:F 28:1) while left liver recipients more commonlyfemale (M:F 5:11) (P = 0.000). Disease severity scored by the Model forEnd-Stage Liver Disease and determined to be of high-urgency fortransplantation were similar between groups. The graft weight to standardliver volume ratio of right liver and left liver groups were matched and were36.9% and 36.4% respectively. Donor right hepatectomy and lefthepatectomy had respectively operation time 405 min and 456 min (P =0.035) and blood loss 300 mL and 406 mL (P = 0.043). In the firstpostoperative week, left liver donors had significantly lower internationalnormalized ratios and serum total bilirubin. None developed complications.Although the rate of return of international normalized ratios for bothgroups were comparable, left liver recipients had significantly higher serumtotal bilirubin and transaminases first week after surgery. The total hospitalstay of recipients of both groups were comparable, intensive care unit stayof the right liver recipients were shorter than the left liver recipients (4days vs. 8.5 days, P = 0.007). Hospital mortality for right liver group was2/29 (6.9%) and left liver group 3/16 (18.8%) (P = 0.330).ConclusionThe more expedient recovery of left liver donors make a case for left liverALDTL whenever feasible. Despite comparable recipient hospitalmortalities of both groups, the longer intensive care unit stay for left liverrecipients raises the caution of assuming the gram-to-gram equivalence ofgrafts from different side of the liver.