Risks faced by donors of right lobe for living donor liver transplantation

BACKGROUND:Because of the shortage of deceased donors with livers fit for transplantation,living donor liver transplantation(LDLT)is becoming an attractive alternative.Attention should be paid to the donors,especially to those of the right lobe.In this study,we evaluated the risks faced by donors of the right lobe for adult-to-adult LDLT.METHODS:The perioperative data from 105 consecutive living donors of the right lobe performed in West China Hospital from January 2002 to December 2007 were retrospectively studied.Preoperative evaluation included CT,MRCP,and intraoperative cholangiography,showing liver volume,hepatic vasculature and the biliary system.The standard liver volume(SLV)and the ratio of left lobe volume to SLV were calculated.The right lobe grafts were obtained by transecting the liver on the right side of the middle hepatic vein without inflow vascular occlusion,using an ultrasonic dissector.After operation the donors were monitored in the Intensive Care Unit for about three days.Each donor was followed up for at least 6 months.RESULTS:There was no donor mortality.Major complications occurred in 14 donors(13.3%),of whom 3 received conservative treatment,8 required invasive paracentesis,and 3 required further surgery.All donors were recovered well and resumed their previous occupations.CONCLUSIONS:Donors of the right lobe face low risks.The preoperative evaluation,especially evaluation of the volume of the remnant liver,should be exact.During the operation,the patency of the remnant hepatic vasculature and bile duct must be preserved,and the extent of injury to the remnant liver should be limited as much as possible.The detection and treatment of postoperative complications should be diligently performed.