Objective: To investigate the safety of adult-to-adult living donor liver transplantation (AALDLT), which means how to make the life safeties of both adult donor and recipient who are transplanted with the right lobe of liver.
Methods: From January 2002 to July 2006, 50 A-ALDLT were performed at West China Hospital, Sichuan University, which consisted of 47 cases with right lobe graft without middle hepatic vein (MHV) and 3 cases with the dual graft of liver lobes (one cases with two left lobes, 2 with one right and one left lobe). The majority of adult liver recipients suffered originally from the hepatitis B with liver cirrhosis (60%), hepatocellular carcinoma (30%) as primary diseases, and 10 cases among them had the model of end-stage liver disease (MELD) score more than 25. The grafting livers of donors were routinely scanned under three-dimensional computed tomography (CT), and the scan image data were computed for volume reconstructions of whole and right lobe livers. Various innovative surgical techniques were adopted for donor and recipient procedure operation.
Results: From 52 living donors, 49 right liver lobes and 3 left lobes were obtained. The 49 right lobe grafts without MHV were weighed to 400-850 g (medial 550 g). The ratios of the graft volumes to the volumes of recipient standard livers (GV/SLV) were ranged from 31. 74% to 71. 68% (mean, 45. 35%). All of the donor remnant liver volumes were larger 35% of the whole liver volume. There was no donor mortality occurring, but 7. 69% of donors undergoing complications in 50 adult recipients. With postoperatively following up 2-52 months (medial 9 months), 13 (26%) occurred various complications and 4 (8%) died within 3 months. Their 1-y actual survival rate was 92%. CONCLUSION When preoperative CT volume showed the volume of remnant liver is greater than 35% of whole liver volume, and the ratio of right lobe graft volume to recipient's standard live volume is more than 40% , A-ALDLT using right lobe graft should be very safe procedure for both donors and recipients, otherwise the dual graft liver transplantation should be considered.