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KMID : 0371420211010010037
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Annals of Surgical Treatment and Research
2021 Volume.101 No. 1 p.37 ~ p.48
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Fates of retained hepatic segment IV and its prognostic impact in adult split liver transplantation using an extended right liver graft
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Chung Yong-Kyu
Hwang Shin
Ahn Chul-Soo
Kim Ki-Hun
Moon Deok-Bog
Ha Tae-Yong
Song Gi-Won
Jung Dong-Hwan
Park Gil-Chun
Yoon Young-In
Kang Woo-Hyoung
Cho Hwui-Dong
Choi Jin-Uk
Kim Min-Jae
Kim Sang-Hoon
Na Byeong-Gon
Lee Sung-Gyu
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Abstract
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Purpose: When splitting a liver for adult and pediatric graft recipients, the retained left medial section (S4) will undergo ischemic necrosis and the right trisection graft becomes an extended right liver (ERL) graft. We investigated the fates of the retained S4 and its prognostic impact in adult split liver transplantation (SLT) using an ERL graft.
Methods: This was a retrospective analysis of 25 adult SLT recipients who received split ERL grafts.
Results: The mean model for end-stage liver disease (MELD) score was 27.3 ± 10.9 and graft-recipient weight ratio (GRWR) was 1.98 ± 0.44. The mean donor age was 26.5 ± 7.7 years. The split ERL graft weight was 1,181.5 ± 252.8 g, which resulted in a mean GRWR of 1.98 ± 0.44. Computed tomography of the retained S4 parenchyma revealed small ischemic necrosis in 16 patients (64.0%) and large ischemic necrosis in the remaining 9 patients (36.0%). No S4-associated biliary complications were developed. The mean GRWR was 1.87 ± 0.43 in the 9 patients with large ischemic necrosis and 2.10 ± 0.44 in the 15 cases with small ischemic necrosis (P = 0.283). The retained S4 parenchyma showed gradual atrophy on follow-up imaging studies. The amount of S4 ischemic necrosis was not associated with graft (P = 0.592) or patient (P = 0.243) survival. A MELD score of >30 and pretransplant ventilator support were associated with inferior outcomes.
Conclusion: The amount of S4 ischemic necrosis is not a prognostic factor in adult SLT recipients, probably due to a sufficiently large GRWR.
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KEYWORD
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Deceased donor, Donor shortage, Extended right liver graft, Left medial segment, Whole liver graft
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