Abstract

A left-lobe graft (LLG) first approach and a purely laparoscopic donor hemihepatectomy (PLDH) are two methods to reduce surgical stress for donors in adult living donor liver transplantation (LDLT). We herein report our strategy to minimize donor risk by applying LLG first combined with PLDH.From 2012-2023, 186 adult LDLTs were performed with hemiliver grafts, procured by open surgery in 95 and PLDH in 91 cases. LLGs were considered first when graft-to-recipient weight ratio =0.6%. Following a four-month adoption process, all donor hepatectomies since December 2019 were performed laparoscopically.There was one intra-operative conversion to open (1%). Mean operative times were similar in laparoscopic and open cases (366 vs. 371 minutes). PLDH provided shorter hospital stay, lower blood loss, and lower peak AST. Peak bilirubin was lower in LLG donors compared to RLG donors (1.4 mg/dL vs. 2.4 mg/dL, P<0.01), and PLDH further improved the bilirubin levels in LLG donors (1.2 vs. 1.6 mg/dL, P<0.01). PLDH also afforded a low rate of early complications (Clavien-Dindo grade = II, 8% vs. 22%, P=0.007) and late complications including incisional hernia (0% vs. 13.7%, P<0.001) compared to open cases. LLG was more likely to have a single duct than RLG (89% vs. 60%, P<0.01). Importantly, with the aggressive use of LLG in 47% of adult LDLT, favorable graft survival was achieved without any differences between type of graft or surgical approach.The LLG first with PLDH approach minimizes surgical stress for donors in adult LDLT without compromising recipient outcomes. This strategy can lighten the burden for living donors, which could help expand the donor pool.

View details for DOI 10.1097/SLA.0000000000005988

View details for PubMedID 37436876