Prevent Small-For-Size Syndrome Using Dual Grafts in Living Donor Liver Transplantation

• Published in: The Journal of surgical research 2009-08, Vol.155 (2), p.261-267
• Main Authors: Chen, Zheyu, M.D., Ph.D, Yan, LuNan, M.D., Ph.D, Li, Bo, M.D., Ph.D, Zeng, Yong, M.D, Wen, TianFu, M.D, Zhao, JiChun, M.D, Wang, WenTao, M.D, Xu, MingQing, M.D, Yang, Jiayin, M.D
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Body Size - physiology; Carcinoma, Hepatocellular - surgery; dual grafts; Female; General aspects; Graft Rejection - prevention & control; Hepatic Veins - surgery; Humans; Liver - surgery; Liver Cirrhosis - surgery; Liver Neoplasms - surgery; Liver Regeneration - physiology; Liver Transplantation - methods; Liver Transplantation - physiology; Liver, biliary tract, pancreas, portal circulation, spleen; living donor liver transplantation; Living Donors; Male; Medical sciences; Middle Aged; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; small-for-size syndrome; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Syndrome; Treatment Outcome
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2009.01.001

Background The growing gap between the number of patients waiting for transplantation and available organs is still the main issue facing the transplant community. The major limitation of adult-to-adult living donor liver transplantation (LDLT) is the small-for-size problem because of the concern of donor safety. We report preliminary experiences for preventing small-for-size syndrome using dual grafts from one right lobe without the middle hepatic vein and one left lateral segment in adult-to-adult LDLT. Methods One hundred ten cases of adult-to-adult LDLT were performed in West China Hospital of Sichuan University from January 2002 to August 2007, and there were 16 small-for-size (SFS) grafts in all grafts. Dual grafts LDLT was performed for six patients with end-stage liver disease, consisting of five cases from one right lobe without the middle hepatic vein and one left lateral segment, and one case from two left lobes. Results All living donors underwent a full recovery from the operation without persistent complications. Four recipients died of sepsis, one recipient received re-transplantation, and three recipients received transplenic artery embolization in the recipients with SFS grafts. All recipients with dual grafts displayed good graft function and a majority of grafts showed normal triangular-shape regeneration of their respective liver grafts. Only in one left lateral segment atrophy occurred, graft hepatectomy was not required. Conclusion Dual grafts from one right lobe without the middle hepatic vein and one left lateral segment in adult-to-adult LDLT can prevent the small-for-size problem and yet secure the safety of the donors.