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Live Donor Adult Liver Transplantation Using Right Lobe Grafts
Donor Evaluation and Surgical Outcome
Elizabeth A. Pomfret, MD,PhD;
James J. Pomposelli, MD,PhD;
W. David Lewis, MD;
Fredric D. Gordon, MD;
David L. Burns, MD;
Anne Lally, MD;
Vassilios Raptopoulos, MD;
Roger L. Jenkins, MD
Arch Surg. 2001;136:425-433.
Hypothesis Live donor adult liver transplantation (LDALT) is a safe and efficacious treatment for patients with end-stage liver disease.
Design Case-control study.
Setting Hepatobiliary surgery and liver transplantation unit.
Patients From December 10, 1998, through April 10, 2000, a single team performed 15 LDALT procedures with 2 simultaneous living donor kidney transplants. During this period, 66 potential donors were screened and evaluated.
Interventions Potential donors were evaluated with 3-dimensional helical computed tomographic scan, including volume renderings for hepatic lobar volume, vascular anatomy, virtual resection planes, and morphologic features. Suitable donors undergo complete medical and psychiatric evaluation and preoperative arteriography.
Main Outcome Measures Donor demographics, evaluation data, operative data, hospital length of stay, and morbidity.
Results A total of 38 men (58%) and 28 women (42%) were evaluated with 15 donors participating in LDALT. Two additional donors provided kidney grafts for simultaneous transplantation at the time of LDALT. Thirty-two donors (48%) were rejected for either donor or recipient reasons, and 10 patients (15%) elected not to participate after initial screening. Three-dimensional volume renderings by helical computed tomographic scan predicted right lobe liver volume within 92% of actual graft volume. Donor morbidity, including all complications, was 67% with no mortality. Residual liver regenerated to approximately 70% of initial volume within 1 week and 80% within 1 month after surgery.
Conclusions Donor evaluation is an important component of LDALT. Significant donor morbidity is encountered even with careful selection. To minimize donor morbidity, groups considering initiating living donor programs should have expertise in hepatic resection and vena cava preservation using the "piggyback" technique during liver transplantation.
From the Departments of Liver Transplantation and Hepatobiliary Surgery (Drs Pomfret, Pomposelli, Lewis, Gordon, Lally, and Jenkins) and Medicine (Dr Burns), Lahey Clinic Medical Center, Burlington, Mass; and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (Dr Raptopoulos).
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