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

Abstract

Purpose of StudyThis study compares the donor and recipient surgical outcomes of ALDLT using right andleft liver grafts of the comparable size including the middle hepatic vein which is unknown.Method and PatientsFrom July 1994 to July 2005, 16 left liver and 207 right liver ALDLT were performed .Among the right liver ALDLT, 29 cases with graft weight to standard liver volume ratiocomparable to left liver group were selected out. Donors, recipients, graft characteristicsand outcomes collected prospectively were analyzed.ResultsThe age of donors and of recipients were comparable between the two groups. Right liverdonors were predominantly female (M:F 2:27) and left liver donors mainly male (M:F14:2) (P = 0.000). The right liver recipients were predominantly male (M:F 28:1) whileleft liver recipients more commonly female (M:F 5:11) (P = 0.000). Disease severityscored by the Model for End-Stage Liver Disease and determined as of high-urgency fortransplantation were comparable for both groups. The graft weight to standard livervolume ratio of right and left groups were matched and were 36.9% and 36.4% respectively.Donor right hepatectomy and left hepatectomy had respectively operation time 405 minand 456 min (P = 0.035) and blood loss 300 mL and 406 mL (P = 0.043). Left liver donorshad significantly lower international normalized ratios and serum total bilirubin the firstweek. None of the left liver donors developed complications. Although the rate of returnof international normalized ratios for both groups were comparable, the left liver recipientshad significantly higher postoperative bilirubin, and transaminases the first week. Thehospital stay of recipients of both groups were comparable. However, the intensive careunit stay of the right liver recipients were significantly shorter (4 days vs. 8.5 days, P =0.007). Hospital mortality for right liver group was 2/29 (6.9%) and left liver group 3/16(18.8%) which did not come to a statistically significant difference with this sample size(P = 0.330).ConclusionsThe lower morbidities and more expedient recovery of the left liver donors favors leftliver ALDLT whenever feasible. The longer intensive care unit stay for left liver recipientsraises the caution to assuming the gram-to-gram equivalence of grafts obtained fromdifferent side of the liver.