Similar donor and recipient outcomes after left lobe and right lobe Living Donor Liver Transplantation

Abstract

BACKGROUND: This study aimed to investigate the impact of graft selection on donor and recipient outcomes in living donor liver transplantation (LDLT). METHODS: This was a retrospective study that involved all patients who had LDLT at a university hospital. Data was retrieved from a prospective collected database from 1996 to 2015. For recipients, we evaluated pre-transplant demographics, MELD, graft size, operative details, portal flow modulation, graft function at day7, complication, and patient and graft survival. For donors, we looked into graft type, postoperative complications, hospital stays and mortality. RESULTS: There’re 579 LDLT during study period (543 right and 36 left lobe). Eighteen (50%) grafts from left lobe with graft weight to estimated standard liver volume (ELSV) ≤ 35% while only 53/543 (9.8%) for right lobe was ≤ 35% (p<0.001). Portal flow modulation was required in 6/36 (16.7%) left lobe and 28/543 (5.2%) right lobe graft (p=0.03). Recipients’ MELD was significantly higher in right lobe (23 vs. 14, p=0.04). Hospital stay was similar (21 vs. 18 days, p=0.38) while ICU stay was longer for left recipients (7 vs. 4 days, p=0.003). There was no difference in 30-day mortality (11.1% for left and 10.1% for right, p=0.3) and 5-year survival (Figure 1). Donor outcomes were better after left lobe donation. Peak INR was 1.2 vs.1.5 (p<0.001) and peak bilirubin was 29 vs. 50umol/L (p<0.001). ICU stay was the same (1 vs. 1 day, p=0.42) and hospital stay was shorter for left lobe donors (6 vs. 8 days, p=0.02). There’s no 30 day or hospital mortality in donors. Overall complications were higher in right lobe donors (5.6 vs. 19%, p=0.04). There’s no difference in recipient outcomes and day 7 graft function after left/right lobe LDLT after adjusting preLT MELD with propensity score matching. CONCLUSION: With left lobe LDLT, portal flow modulation was more required to prevent small for size syndrome. Left lobe donors have better outcomes while recipient survival at 5-year was the same. In carefully selected patients, left lobe LDLT provides similar outcomes as to right lobe donation.