Various types of donor hepatectomy according to the required graft volume in adult living donor liver transplantation

[Living donor liver transplantation]

Sixteen years after its first successful application, living donor liver transplantation now has a small but well-established role in treatment for liver failure in Germany. It remains problematic in both child and adult patients concerning effort, expected results, and assessment of risks to the donor. Therefore the method shall remain limited to more research-oriented institutions for the time being before it can be established more broadly as an alternative to postmortal donation. In Germany it presents generally the same limitations as living donor kidney transplantation.

Safety of right lobectomy in living donor liver transplantation

The goal of this study was to examine the safety and effectiveness of right lobectomy in living donor liver transplantation (LDLT). From January 1999 to January 2002, 100 cases of LDLT were performed at Seoul National University Hospital; 45 involved right lobectomy (RL), 17 involved extended left lobectomy (ELL), 37 involved left lateral segmentectomy (LLS), and 1 involved right posterior segmentectomy. The outcome of RL was compared with those of other types of hepatectomy. An RL resulted in a longer operative time (minutes) than an LLS (349.0 +/- 65.1 versus 286.7 +/- 54.0, P < .01), but not an ELL (351.2 +/- 84.3, P = .99). The hospital stay (days) in the RL group (14.4 +/- 3.1) was longer than for those in the ELL group (11.7 +/- 1.7, P < .01) and the LLS group (11.7 +/- 1.9, P < .01). The drain amount (mL) of the postoperative third day in the RL group (194.4 +/- 143.4) was larger than for those in the ELL group (56.8 +/- 84.1, P < .01) and the LLS group (46.5 +/- 39.6, P < .01). The postoperative peak serum level of total bilirubin (mg/dL) was 3.0 +/- 1.5 in the RL group, 1.9 +/- 0.7 in the ELL group, and 1.9 +/- 0.9 in the LLS group (P < .01, RL versus LLS, ELL). There was no mortality or major morbidity and no reoperation of donors. Right lobectomy is a relatively safe and effective procedure in LDLT, but brings more potential risks and morbidity in donors.