Effect of side and size of graft on surgical outcomes of adult-to-adult live donor liver transplantation

By virtue of size, the right liver graft has become the workhorse of adult-to-adult live donor liver transplantation (ALDLT). Although favorable results of left liver ALDLT have also been reported, a head-to-head comparison of these 2 graft types both containing the middle hepatic vein had not been made. In this study, we compared the outcomes of 29 right liver and 16 left liver ALDLTs of comparable graft weight to recipient estimated standard liver volume ratio (GW/ESLV, 36.9% and 36.4%, respectively). All liver grafts contained the middle hepatic vein. The Model for End-Stage Liver Disease (MELD) score and urgency for transplantation of both groups were similar. Postoperatively, left liver donors had significantly lower international normalized ratios and serum total bilirubin levels and no complications. Although the rate of return of international normalized ratios for recipients of both groups were comparable, left liver recipients had significantly higher serum total bilirubin and serum aminotransferase levels. Intensive care unit stay of the left liver recipients was longer than that of the right liver recipients (8.5 days versus 4 days, P = 0.007). Hospital mortality was 6.9% (2/29) for the right liver group and 18.8% (3/16) for the left liver group (P = 0.330). Safety profile of donor left hepatectomy was higher. However, despite similar GW/ESLV, the more arduous recovery and higher mortality rate of left liver recipients raise the caution of assuming the gram-to-gram equivalence of right and left liver grafts.