Remnant left liver size and recovery of living right liver donors

Abstract

Purpose: Living donor liver transplantation is a realistic life-saving treatment in regions where deceased donor organs are scarce. The minimum remnant left liver volume (RLLV) requirement for donor right hepatectomy (DRH) varies in different programs of living donor liver transplantation. The present study aimed to determine how significant the RLLV is in the recovery of right liver donors.

Method: A total of 349 consecutive donors who underwent DRH including the middle hepatic vein were divided into nine groups according to the percentage of the RLLV. The peak and recovery of the serum bilirubin level and prothrombin time (PT) in the 1st week after operation and postoperative complications were studied.

Results: The median RLLV was 35.5 (27-49.5) %. Postoperative peak serum bilirubin was highest [74 (25-133) μmol/L] in the group with RLLVs <30 %. This group also had the highest peak PT [18.9 (15.4-24.4) s], although results were similar between groups. Total bilirubin peaked on postoperative days 1-2 in groups with RLLVs ≥35 %. In groups with RLLVs <35 %, total bilirubin peaked on day 3. PT took 1-2 days to peak and nearly approached preoperative values on day 7 in all groups. Complication rates ranged from 0 to 75 %. The rates of complications of Clavien-Dindo grade 3 or above ranged from 0 to 3.8 %. Postoperative peak bilirubin was associated with severe complications (p = 0.031). Age, postoperative peak PT, and RLLV were independent risk factors for prolonged hospital stay.

Conclusion: There was a demonstrable trend of slower recovery of liver function in donors with smaller RLLVs.

Keywords: Living donor liver transplantation; Remnant; Size.