TITLE: THE FIRST 30 ADULT TO ADULT LIVING DONOR LIVER TRANSPLANTS UTILIZING THE RIGHT LOBE IN THE SINGLE CENTER

AUTHORS: Mitsuru Nakatsuka, MD, Robert A. Fisher, MD, Marc P. Posner, MD, John M. Ham, MD, Amadeo Marcos, MD
AFFILIATION: Medical College of Virginia of VCU, Richmond, VA.

INTRODUCTION: Living donor liver transplant (LDLTx) has become an option for adult recipients. As more centers in the U.S. start and continue to perform this procedure, continuous evaluation of donor selection protocols, surgical technique, and donor recipient results is warranted.
METHODS: Donors were only considered after recipients were listed. Workup included liver biopsy, MR with volumetric measurements of the right lobe (RL), and angiography. Minimal graft to recipient body weight (GRBW) ratio considered was 0.8. Donor operation consisted of a right lobectomy assisted by cholangiography and intraoperative ultrasonography. RL mass was then determined and compared to MR calculated mass. Tacrolimus, mycophenolate, and standard steroid taper were used for immunosuppression in all recipients.
RESULTS: From June 1998-June 1999, 30 LDLTx were performed at our center. 19% of the donors that successfully completed the initial screening were excluded based on steatosis on liver biopsy or that they did not yield the minimal GRBW ratio (6) or angiography (1). Mean follow up was 174±107 days (12- 362). Donors: Mean intraoperative blood loss was 645±510 cc (221-1900), MR overestimated RL mass by 45 ± 65 g (10-123), hospital stay was 5.6±1.6 days (4-10) with no readmissions. Complications in donors included pressure scores (3), atelectasis (2), and prolonged ileus (1). Recipients: Status at OLTIIA (5), IIB(23), and III(2). Mean initial hospital stay was 14.5±11.9 days (6-56), readmission rate was 0.9±1.4 (0-5), total hospital stay was 26±23 days (6-84). Complications were significant for biliary (6), sepsis (5), seizure (2), the incidence of biliary complications decreased to 13% in the second half of the study. Mortality included 4 patients, 3 of them were status IIA at transplant, 2 of them with prior OLT, all due to uncontrolled sepsis at 30, 62, 65, and 213 days, all with working grafts. Three of these 4 patients were transplanted at the first half of the study.
CONCLUSIONS: Liver biopsy was useful in determining the real liver mass for GRBW calculation. MR correlated well with final RL mass. Refinements in donor hepatectomy translate to lower morbidity for the recipients. LDLTx seems to be a safe operation for the donor with good results in adult recipients.