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Sheung-Tat Fan, MS, MD, FRCS(Glasg and Edin); Chung-Mau Lo, MS, FRACS, FRCS(Edin); Chi-Leung Liu, MBBS, FRCS(Edin); Boon-Hun Yong, MBBS, MRCP; John Ka-Fat Chan, MBBS, DMRD, FRCR; Irene Oi-Lin Ng, MD, FRCPath

Arch Surg. 2000;135:336-340.

Hypothesis  Right lobe donation was advocated for adult-to-adult live donor liver transplantation but the safety of the donor is still a major concern. We hypothesize that right lobe donation is safe if the lowest limit of volume of liver remnant that can support donor survival is known.

Design  Retrospective analysis of data collected prospectively.

Setting  Tertiary hepatobiliary surgery referral center.

Patients  Twenty-two live donors involved in adult-to-adult right lobe liver transplantation from May 1996 to June 1999.

Interventions  The right lobe grafts were obtained by transecting the liver on the left side of the middle hepatic vein. Liver transection was performed by using an ultrasonic dissector, without using the Pringle maneuver. The left lobe volume was measured by computed tomographic volumetry and the ratio of left lobe volume to the total liver volume was calculated.

Main Outcome Measures  Hospital mortality rate and complication rate.

Results  The median blood loss was 719 mL (range, 200-1600 mL). Only one donor, who had thalassemia, received 1 U of homologous blood transfusion. Postoperative complications included wound infection, incision hernia, and cholestasis in 1 donor whose liver showed 20% fatty change and who had a left lobe–total liver volume of 0.34. Another donor with 15% fatty change in the liver and a left lobe–total liver volume ratio of 0.27 developed prolonged cholestasis. Two other donors with left lobe–total liver volume ratios of 0.27 but with mild steatosis (<5%) did not develop postoperative cholestasis. Postoperative complications also included 1 case of biliary stricture and 1 case of small bowel obstruction. Both complications were adequately treated. There was no donor mortality. All donors are well and have returned to their previous occupations.

Conclusion  Live donation of right lobe graft for adult-to-adult liver transplantation is safe provided that the residual liver volume exceeds 30% of the total liver volume and the liver itself is normal or only mildly affected by steatosis.

From the Center of Liver Diseases, Departments of Surgery (Drs Fan, Lo, and Liu), Anesthesiology (Dr Yong), Diagnostic Radiology (Dr Chan), and Pathology (Dr Ng), The University of Hong Kong, Hong Kong.

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