Left lobe adult-to-adult living donor liver transplantation: Small grafts and hemiportocaval shunts in the prevention of small-for-size syndrome

Jean F. Botha, Alan Norman Langnas, B. Daniel Campos, Wendy J. Grant, Christopher E. Freise, Nancy L. Ascher, David F Mercer, John P. Roberts

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

Adult-to-adult living donor liver transplantation (AA-LDLT) has better outcomes when a graft weight to recipient weight ratio (GW/RW) > 0.8 is selected. A smaller GW/RW may result in small-for-size syndrome (SFSS). Portal inflow modulation seems to effectively prevent SFSS. Donor right hepatectomy is associated with greater morbidity and mortality than left hepatectomy. In an attempt to shift the risk away from the donor, we postulated that left lobe grafts with a GW/RW < 0.8 could be safely used with the construction of a hemiportocaval shunt (HPCS). We combined data from 2 centers and selected suitable left lobe living donor/recipient pairs. Since January 2005, 21 patients underwent AA-LDLT with left lobe grafts. Sixteen patients underwent the creation of an HPCS between the right portal vein and the inferior vena cava. The portocaval gradient (portal pressure - central venous pressure) was measured before the unclamping of the shunt and 10 minutes after unclamping. The median actual graft weight was 413 g (range = 350-670 g), and the median GW/RW was 0.67 (range = 0.5-1.0). The portocaval gradient was reduced from a median of 18 to 5 mmHg. Patient survival and graft survival at 1 year were 87% and 81%, respectively. SFSS developed in 1 patient, who required retransplantation. Two patients died at 3 and 10 months from a bile leak and fungal sepsis, respectively. The median recipient bilirubin level and INR were 1.7 mg/dL and 1.1, respectively, at 4 weeks post-transplant. One donor had a bile leak (cut surface). This is the first US series of small left lobe AA-LDLT demonstrating that the transplantation of small grafts with modulation of the portal inflow by the creation of an HPCS may prevent the development of SFSS while at the same time providing adequate liver volume. As it matures, this technique has the potential for widespread application and could positively effect donor safety, the donor pool, and waiting list times.

Original languageEnglish (US)
Pages (from-to)649-657
Number of pages9
JournalLiver Transplantation
Volume16
Issue number5
DOIs
StatePublished - May 1 2010

Fingerprint

Living Donors
Liver Transplantation
Transplants
Weights and Measures
Tissue Donors
Hepatectomy
Bile
Portal Pressure
Central Venous Pressure
International Normalized Ratio
Waiting Lists
Inferior Vena Cava
Graft Survival
Portal Vein
Bilirubin
Sepsis
Transplantation
Morbidity
Safety
Survival

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Left lobe adult-to-adult living donor liver transplantation : Small grafts and hemiportocaval shunts in the prevention of small-for-size syndrome. / Botha, Jean F.; Langnas, Alan Norman; Daniel Campos, B.; Grant, Wendy J.; Freise, Christopher E.; Ascher, Nancy L.; Mercer, David F; Roberts, John P.

In: Liver Transplantation, Vol. 16, No. 5, 01.05.2010, p. 649-657.

Research output: Contribution to journalArticle

Botha, Jean F. ; Langnas, Alan Norman ; Daniel Campos, B. ; Grant, Wendy J. ; Freise, Christopher E. ; Ascher, Nancy L. ; Mercer, David F ; Roberts, John P. / Left lobe adult-to-adult living donor liver transplantation : Small grafts and hemiportocaval shunts in the prevention of small-for-size syndrome. In: Liver Transplantation. 2010 ; Vol. 16, No. 5. pp. 649-657.
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