Y.J Lee

Seventeen adult-to-adult living donor liver transplantations using dual grafts.

THE MAJOR limitation of adult-to-adult living donor liver transplantation (A-A LDLT) is the adequacy of the graft size. It has been known that 50% of the standard liver volume of the recipient is the minimum liver graft volume required to provide adequate functional hepatocytes. A left lobe from a relatively small volunteer donor will not meet the metabolic demands of a larger recipient. The possible solutions to this problem are to increase the extent of resection in the donor by harvesting the right lobe of the liver, which accounts for 60% to 70% of the total liver mass, to apply an auxiliary partial orthotopic liver transplantation (APOLT), or to implant dual grafts into one recipient. The right lobe harvest in the donor is not always safe, depending mainly on the volume of the remaining left lobe. Even though the donor has sufficiently large right lobe that is adequate as a graft for an adult recipient, the remaining left lobe may be too small to produce a threat to donor safety in many occasions. In this instance, the donor cannot be allowed to donate either side of the liver lobe for a large-size adult recipient. As an alternative, dual left lobe or left lateral segment from two living donors can solve the problem of graft-size insufficiency and guarantee donor safety. Furthermore, if the large-size recipient requires a bigger graft liver volume than the volume of the sum from two potential living donors’ left lobes, and if the right lobe harvested from one of two potential donors seems to be safe, one right lobe and one left lobe from two donors can be transplanted into a single recipient to avoid a small-forsize graft problem. The present study aims to introduce the usefulness of dual-graft A-A LDLT by review of our single-center experience.

Correlation of blood-free graft weight and volumetric graft volume by an analysis of blood content in living donor liver grafts

ASSESSMENT OF GRAFT SIZE is an essential step for living donor liver transplantation (LDLT). Preoperative evaluation by computed tomogram (CT) or magnetic resonance volumetry of living donor livers has been a routine procedure for matching graft sizes. Liver grafts are also weighed at the back table during the operation. At this time, there is usually a significant discrepancy between the graft volume from preoperative volumetry (volumetric graft volume) and the real graft weight. This difference can be caused by inaccurate volumetric measurement from improper CT images with some respiratory movement; its possibility cannot be negligible because even high-speed CT machines require breath-holding of about 20 seconds. Another possible cause can be the differences between the measurement plane of liver parenchyma used for volumetry and the real transection plane of the liver. However, neither the exact parenchymal transection along the preoperative measurement plane nor the repeated measurement of volumetry along the real transection plane after donor operation makes the volumetric graft volume exactly match the graft weight. Another possible cause is blood content itself in the graft, in which the graft weight measured at the back table is usually blood-free. We have measured the amount of blood in the grafts and analyzed the correlation between volumetric graft volume and graft weight. This observation may serve as an interchangeable bridge over blood-free graft weight and blood-filled graft volume.