Although right lobe (RL) grafts with middle hepatic vein (MHV) allows better venous drainage for the recipient in living donor liver transplantation (LDLT), MHV harvest is still controversial due to concerns about donor safety. This study compares both donor and recipient outcomes in 100 consecutive RL LDLTs. In a median follow-up of 22 months, none of the donors had either severe (grade 4) complications or mortality. Although, overall morbidity was higher in donors with MHV (n=49) compared to those without MHV (n=51) (7.8% vs. 22.4% respectively, p=0.05), the morbidity rates were similar between the groups when remnant liver volume (RLV) was >30% (7.3% vs. 16.7%, p=0.2). The highest complication rate (57%) was seen in donors who underwent MHV harvest when RLV was <30% (p=0.009; OR=9.9 (1.9-50.4), %95 CI). On the contrary, transaminase peak levels and bilirubin levels during the first postoperative week were significantly lower in recipients of grafts with MHV. Regarding equivalent graft volumes and ischemia times among the groups, this was interpreted as less hepatic injury in RL grafts with MHV. The results of this comparative study show that live donor right lobectomy with MHV harvest does not affect morbidity in appropriately selected donors, while recipients of RL grafts with MHV have less hepatocyte injury and better early liver function. We conclude that, MHV should not be harvested in donors with RLV of less than 30%.
Volume : 6
Issue : 4
Pages : 14
Florence Nightingale Hospitals, Istanbul, Turkey.