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Leaning to the Left - Increasing The Donor Pool by Using The Left Lobe, Outcomes of the Largest Single Center Western Experience of Left Lobe Adult Living Donor Liver Transplantation (LDLT)
Karim J Halazun*1, Benjamin Samstein*1, Fabrizio Michelassi1, Eric M Przybyszewski*2, Daniel Cherqui*1, Adam D Griesemer*2, James V Guarerra*2, Tomoaki Kato2, Robert S Brown, Jr.*1, Jean C Emond2
1Weill Cornell Medical College, New York, NY;2Columbia University Medical Center, New York, NY

Objective Centers offering adult-LDLT mostly use right lobe grafts (RLG) due to fears of providing recipients with insufficient hepatic volume, and the technical challenges presented by using left lobe grafts (LLG). LLGs therefore represent <5% of adult-LDLTs performed in the US. Here we present the largest western experience with the use of LLG for adult-LDLT.
Methods Analysis of a single center prospective database of LDLTs performed from 1998-2015.
Results 214 adult-LDLTs were performed during the study period. 56 patients (26%) received LLG. Table 1 compares the outcomes of LLG versus RLG recipients. LLG recipients were more likely to be women, had significantly lower BMI, graft-weight and graft-weight-recipient-weight ratios. There were no significant differences in vascular or biliary complications, or in patient or graft survival at 1,3 and 5-years (p=0.747 and p=0.398 respectively). The significantly increased risk of small-for-size-syndrome observed in LLG recipients did not increase the risk of re-transplant within 90-days or perioperative mortality in LLG recipients (p=0.308 & p=0.932 respectively). Graft type did not predict patient or graft outcomes on regression analysis (p=0.857 & 0.399 respectively).
Conclusions Despite smaller graft sizes, outcomes of adult-LDLT using LLG are comparable to RLG transplants. Achieving comparable outcomes with a lesser donor hepatectomy may increase the acceptance of LDLT in North America and Europe, and greatly increase the donor pool in an era of severe organ shortages.
Table 1: Comparison of Demographics & Outcomes Between LLG & RLG Recipients
Left Lobe Graft (LLG)
26%(n=56)
Right Lobe Graft (RLG)
74%( n= 158)
p-Value
Demographics
Mean Age50.4 ± 16.2 yrs52.3 ±10.3 yrs0.859
Gender (% Male)42.9% (n=24)59.5% (n=94)0.031*
Median BMI (IQR)23 (IQR 21-27)27 (IQR 24-30)0.002*
Median MELD (IQR)13 (IQR 10-17)15 (IQR 12-20)0.09
Diagnosis of HCV44.6% (n=25)50.6% (n=80)0.467
Graft Characteristics
Median Graft Weight (IQR)484g (438-550)805g (702-950)<0.001*
Median GWRW ratio (IQR)0.79 (0.63-0.93)1.03 (0.88-1.21)<0.001*
Complications
Hepatic Artery Thrombosis5.4% (n=3)2.4% (n=4)0.307
Portal Vein Thrombosis3.6% (n=2)3.8% (n=6)0.939
Bile Leak33.9%( n=19)29.7% (n=47)0.560
Biliary Stricture32.1% (n=18)35.4% (n=56)0.655
Small for Size Syndrome5.4% (n=3)0% (n=0)0.003*
Re-Transplant within 90 days7.1% (n=4)3.8% (n=6)0.308
Survival
30 Day Mortality5.4% (n=3)5.1% (n=8)0.932
Patient Survival at 1,3,5 years89%, 79%, 76%89%, 84%, 78%0.747
Graft Survival at 1,3,5 years82%, 72%, 72%85%, 81%, 73%0.398
Abbreviations: BMI: Body Mass Index, IQR: Interquartile Range, MELD: Model of End Stage Liver Disease GWRW ratio: Graft-Weight-Recipient-Weight Ratio


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