Right Posterior Segment Graft in Adult Living-Donor Liver Transplantation: A Report of 17 Years of Experience at a Single Institution.

OBJECTIVES

The right posterior segment graft can be selected in cases where neither the right nor left lobe graft satisfies the selection criteria for adult living donor liver transplant. However, vascular and biliary anatomy may cause technical difficulties in procurement of posterior segments in donors of living donor liver transplant and may require specific attention in vascular and biliary reconstruction in the recipient. In this study, we examined the feasibility of right posterior segment grafts in adult living donor liver transplants through donor safety and recipient outcomes and clarified the anatomic points of the surgical technique.

MATERIALS AND

METHODS

We retrospectively reviewed 296 cases of adult living donor liver transplants treated at Kumamoto University between August 2000 and March 2017.

RESULTS

Among 296 cases, graft types were right lobe (n = 162), left lobe (n = 119), and right posterior segments (n = 9). Among donors, no significant differences were shown in operative time, blood loss, or incidence of postoperative complications between early and late phases among the 3 groups. Four cases ofright posterior segment had >2 biliary duct stumps, and 2 cases had 2 portal vein stumps. Among recipients, median actual graft-to-recipient weight ratio was 0.82% (range, 0.52%-1.22%), with no factors, including graft type, significantly associated with graft survival. Hepatic artery thrombosis and rupture of hepatic artery pseudoaneurysm occurred in 1 case as an early complication, and biliary anastomotic stricture occurred in 4 cases as a late complication.

CONCLUSIONS

The right posterior segment graft may be an effective alternative in living donor liver transplant when no eligible candidates for conventional grafts are available among families and relatives. Careful preoperative anatomic evaluations and simulations are important.