Complications of right lobe living donor liver transplantation☆

Background/Aims

Right lobar living donor liver transplantation (LDLT) has been controversial because of donor deaths and widely variable reports of recipient and donor morbidity. Our aims were to ensure full disclosure to donors and recipients of the risks and benefits of this procedure in a large University center and to help explain reporting inconsistencies.

Methods

The Clavien 5-tier grading system was applied retrospectively in 121 consecutive adult right lobe recipients and their donors. The incidence was determined of potentially (Grade III), actually (Grade IV), or ultimately fatal (Grade V) complications during the first post-transplant year. When patients had more than one complication, only the seminal one was counted, or the most serious one if complications occurred contemporaneously.

Results

One year recipient/graft survival was 91%/84%. Within the year, 80 (66%) of the 121 recipients had Grade III (n=54) Grade IV (n=16), or Grade V (n=10) complications. The complications involved the graft’s biliary tract (42% incidence), graft vasculature (15%), or non-graft locations (9%). Complications during the first year did not decline with increased team experience, and adversely affected survival out to 5 years. All 121 donors survive. However, 13 donors (10.7%) had Grade III (n=9) or IV (n=4) complications of which five were graft-related.

Conclusions

Despite the satisfactory recipient and graft survival at our and selected other institutions, and although we have not had a donor mortality to date, the role of right lobar LDLT is not clear because of the recipient morbidity and risk to the donors.

Keywords: Liver transplantation, Complications, Biliary tract, Hepatic artery, Living donation, Right lobe

Abbreviations: LDLT, living donor liver transplantation, UPMC, University of Pittsburgh Medical Center, UNOS, United Network for Organ Sharing, MELD, model for end-stage liver disease, IRB, Institutional Review Board, SFSS, small for size syndrome, NASH, non-alcoholic steatohepatitis, NIH, National Institute of Health, A2ALL, NIH-funded 9-center adult to adult living donor liver transplant consortium