INTRODUCTION: A right lobe living related liver transplantation (LRLT) was performed for the first time in Italy on March 16, 2001 at our institution. METHODS: All donors underwent celiac and mesenteric axis angiography. Computed tomography scan to determinate the liver size and anatomical vascular variation, cholangio-magnetic resonance imaging, intraoperative cholangiography, and ultrasonography. All recipients were status 2B on the waiting list for cadaveric liver transplants. The surgical procedures were carried out by grafting segments 5, 6, 7, and 8 of the donor liver. RESULTS: Of the donors, all are alive; 4 had uneventful postoperative courses, 3 had moderate right pleural effusions; 3 had bilious drainage that resolved spontaneously: and 1 had a biliary leak and a pulmonary embolism. Of the recipients, 8 are alive with well-functioning grafts. One recipient has undergone retransplantation due to an arterial thrombosis and another recipient developed a stricture of the biliary anastomosis. Two recipients died: one because of pulmonary hemorrhage in Rendu-Osler syndrome, the other as a consequence of overwhelming systemic aspergillosis. CONCLUSIONS: Our experience suggests that few anatomical vascular and biliary variations are considered contraindications for right lobe LRLT. This challenging surgical procedure seems effective for well-selected recipients of United Network for Organ Sharing II B status. Appropriate recipient selection is crucial as we face a living donor.
INTRODUCTION: A right lobe living related liver transplantation (LRLT) was performed for the first time in Italy on March 16, 2001 at our institution. METHODS: All donors underwent celiac and mesenteric axis angiography. Computed tomography scan to determinate the liver size and anatomical vascular variation, cholangio-magnetic resonance imaging, intraoperative cholangiography, and ultrasonography. All recipients were status 2B on the waiting list for cadaveric liver transplants. The surgical procedures were carried out by grafting segments 5, 6, 7, and 8 of the donor liver. RESULTS: Of the donors, all are alive; 4 had uneventful postoperative courses, 3 had moderate right pleural effusions; 3 had bilious drainage that resolved spontaneously: and 1 had a biliary leak and a pulmonary embolism. Of the recipients, 8 are alive with well-functioning grafts. One recipient has undergone retransplantation due to an arterial thrombosis and another recipient developed a stricture of the biliary anastomosis. Two recipients died: one because of pulmonary hemorrhage in Rendu-Osler syndrome, the other as a consequence of overwhelming systemic aspergillosis. CONCLUSIONS: Our experience suggests that few anatomical vascular and biliary variations are considered contraindications for right lobe LRLT. This challenging surgical procedure seems effective for well-selected recipients of United Network for Organ Sharing II B status. Appropriate recipient selection is crucial as we face a living donor.
Authors: Antoni Riera-Mestre; Pau Cerdà; Yoelimar Carolina Guzmán; Adriana Iriarte; Alba Torroella; José María Mora-Luján; Jose Castellote; Amelia Hessheimer; Constantino Fondevila; Laura Lladó Journal: J Clin Med Date: 2022-09-24 Impact factor: 4.964