Korean J Transplant.  2022 Nov;36(Supple 1):S365. 10.4285/ATW2022.F-5063.

Remnant liver volume ratio less than 30% is not contraindication to living donor right hepatectomy

• Kim J
• Choi DL
• Han JR
• Han YS

• KMID: 2535239
• DOI: http://doi.org/10.4285/ATW2022.F-5063

Abstract

The current practice of arbitrarily requiring remnant/total volume ratio (RTVR) of at least 30% is still performed based on the experience of early studies to keep donor safety during living donor right hepatectomy (LDRH). Recently, some centers reported that extended resection with RTVR less than 30% for LDRH, but there is no consensus has been established for safe RTVR limit. Herein, we describe out center’s experience for LDRH with RTVR <30% and evaluate the outcomes of living donors with RTVR <30%. We retrospectively reviewed the outcomes of 473 LDRH which performed at our institution from January 2010 to Decem-ber 2020. We performed right hepatectomy for living donors with RTVR <30% under the following criteria: age ≤40 years, preser-vation of middle hepatic vein, no or minimal fatty changes (<15%), flat fish shaped left hemiliver, and RLV/TLV >25% and FRLV/BW ≥0.45. The outcomes in these extended criteria for living donors were compared with those in living donors under conventional criteria. Posthepatectomy liver failure (PHLF) occurred in 50 donors (10.6%) and most cases were grade A except one case and no clinically significant PHLF was not evident for these extended donor criteria group. PHLF and major complications did not occur more frequently in living donor group with RTVR <30%. In multivariate analysis, the only event for major complications and FRLV/BW <0.45 were associated with PHLF but RTVR <30% was not related to PHLF. Moreover, even after propensity score matching analysis, the evidence for PHLF and major complications in RTVR <30% group was not frequent compared to conven-tional criteria group. In conclusion, LDRH under our extended criteria could be performed safely in donors with RTLV ratio <30% under our strict criteria when no other living donors are available.