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KMID : 0371320050680020123
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Journal of the Korean Surgical Society
2005 Volume.68 No. 2 p.123 ~ p.127
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An Analysis on the Usefulness of Concomitant Procurement of the Caudate Lobe in Living Donor Liver Transplantation Using a Left Lobe Graft
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하태용/Ha TY
이승규/황신/박광민/김기훈/안철수/문덕복/김건국/김연대/Lee SG/Hwang S/Park KM/Kim KH/Ahn CS/Moon DB/Kim KK/Kim YD
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Abstract
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Purpose: Procuring the left liver lobe plus the caudate lobe was originally done in an effort to increase the graft mass itself. However, there has been some controversy about the procedure´s effectiveness. We investigated the effect of concomitant caudate lobe transplantation and fates of the implanted caudate lobe.
Methods: From January 2002 to December 2003, 290 cases of living donor liver transplantation (LDLT) were performed at our institution. Among them, there was 31 case of adult-to-adult LDLT using a left lobe plus the caudate lobe. The volumes of left lobe and caudate lobe were measured separately by using computed tomogram (CT) volumetry. The operation time for the concomitant caudate lobe procurement took an average of an additional 30 minutes over the routine left lobe procurement because of the dissection of the retrohepatic vena cava. There was no separate caudate duct in the 31 consecutive grafts in this series.
Results: The graft weight of the left lobe plus the caudate lobe was 455±55 gm, yielding a mean graft-recipient weight ratio of 0.79±0.11. Volumetry of the preoperative donor CT scan revealed that the volume of the caudate lobe was 24±6 ml, which was equivalent to 5% of the left lobe volume. We prepared the largest single caudate vein with a caval patch and then reconstructed it in 24 recipients. The regeneration rate of the caudate lobe after transplantation was 116% after 1 week and 121% after 1 month. On the other hand, the regeneration rate of the left lobe was 193% after 1 week and 227% after 1 month. The regeneration rate for the left lobe was greater than that for the caudate lobe. 29 of the 31 recipients survived.
Conclusion: We think that increasing the graft mass by 5% justifies to performing the concomitant caudate lobe procurement at the expense of 30-minute’s effort.
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