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Left Out? Safety in Live Left Lobe Liver Donation
*Manuel I Rodriguez-Davalos, *Roger Patron-Lozano, *James T. Tooley, *Peter S. Yoo, *Stephen M. Luczycki, *Michael Schilsky, *David C. Mulligan, *Sukru H. Emre
Yale University School of Medicine, New Haven, CT
Objective:
Compare the incidence and severity of post-operative complications of left-lobe (LL) versus right-lobe (RL) live-liver-donation (LLD) in a single institution.
Design:
Retrospectively analyzed LLD charts for patient demographics, post-operative complications, and length of stay (LOS). We combined left-lateral-segment (LLS) resections with LL resections under the LL group.
Setting:
University hospital.
Patients:
All patients undergoing hepatectomies for LLD at our institution.
Interventions:
We analyzed the post-operative complications in left versus RL living-donor hepatectomies.
Main Outcome Measures:
Post-operative complications using the Clavien-Dindo Classification.
Results:
58 living-donor liver transplants (LDLTx) were done from 03/08-03/14. 29(50%) were male and the average age was 38.2+/-10.5 years. 19(32.76%) were RL donations and 39(67.24%) were either LLS (n=17,29.31%) or LL donations(n=22,37.93%). The mean LOS was 7.05+/-2.66 days for right hepatectomies and 6.92+/-3.26 days for the LL group (p=0.881). The incidence of Grade II or greater complications was 17.9%(n=7) for the LL group and 47.37%(n=9) for the RL group (p=0.029) (Table-1). The odds of being a RL donor with a grade II or higher complication was 4.11 (95% CI [1.22-13.89] p=0.023).
Conclusions:
Even though the majority of transplant centers in the United States prefer RL over LL for LDLTx, we didn’t observe a difference in LOS when the donors were subjected to a LL or LLS hepatectomy. However, we observed that the incidence and severity of complications of RL LLD are higher when compared to their left counterparts. This study, although small, should prompt an impulse towards LL LLD, an almost abandoned practice in the western world.
Complications by Severity| Surgical Complication Grade (Clavien-Dindo) | Overall
(n=58) | Left Lobes + LLS
(n=39) | Right Lobes
(n=19) | p value | | Total Complications | 23 39.66% | 14 35.90% | 9 47.37% | 0.568 | | I | 7 12.07% | 7 17.95% | 0 0.00% | | | Clavien-Dindo ≥ Grade II | | | | 0.029 | | II | 6 10.34% | 5 12.82% | 1 5.26% | | | III-a | 4 6.90% | 0 0.00% | 4 21.05% | | | III-b | 5 8.62% | 2 5.13% | 3 15.79% | | | IV-a | 1 1.72% | 0 0.00% | 1 5.26% | | | IV-b | 0 0.00% | 0 0.00% | 0 0.00% | | | V | 0 0.00% | 0 0.00% | 0 0.00% | |
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