Outcome and challenges of left-lobe living-donor liver transplantation in adults

Background Left-lobe (LL) liver grafts have become once again the preferred option during the process of graft selection in many transplant centers worldwide. Minimizing donor morbidity, which has been reported to be higher with donation of the larger right-lobe (RL) graft, was the principal motivation. The aim of this work was to evaluate the outcome of living-donor liver transplantation (LDLT) using LL grafts in adults. Patients and methods A single-center retrospective study that included all adult patients who underwent LDLT between July 2018 and June 2020. Thirty-eight patients underwent LDLT, 13 patients received LL grafts, while 25 patients received RL grafts. The two groups were compared in terms of patient and graft survival, incidence of various posttransplant complications, and incidence of small-for-size syndrome. Donor morbidity was evaluated as well. Results There was no difference between LL and RL graft recipients regarding patient and graft survival. The incidence of posttransplant complications also did not differ significantly between both groups. Only one LL recipient with a graft-to-recipient weight ratio of 0.56 experienced small-for-size syndrome, however, the outcome in this patient did not differ from that of other patients. RL donors had a statistically significant higher postdonation peak total serum bilirubin (P<0.001). Conclusion LL grafts are a feasible option for adult LDLT. Transplant surgeons should always consider selecting LL as their primary graft according to a clear graft-selection algorithm. RL grafts can carry more risk to the healthy donors and should be selected only when LL grafts are deemed unsuitable.