Korean J Transplant.  2022 Nov;36(Supple 1):S55. 10.4285/ATW2022.F-1745.

The unusual grafts for living donor liver transplantation

• Yim SH
• Min EK
• Choi MC
• Kim DG
• Lee JG
• Han DH
• Joo DJ
• Choi GH
• Kim MS

• KMID: 2535259
• DOI: http://doi.org/10.4285/ATW2022.F-1745

Abstract

Background
To find an adequate graft for living donor liver transplantation (LDLT), the left lobe and the right lobe grafts of the liver were introduced. However, the left lobe graft has a possibility of a small-for-size syndrome, and the right lobe graft has donor safety issues. Then, an extended left liver plus caudate lobe graft (Ext LLC), right anterior section graft (RASG), and right posterior section graft (RPSG) are introduced as alternative options to consider. This study looks at the results of these unusu-al grafts in LDLT.
Methods
In total, 497 recipients underwent an LDLT at Severance Hospital between January 2016 and December 2021. Pa-tients who have received grafts from two separate donors, re-LT patients, and pediatric LT recipients were excluded. Ten patients were found to be the recipients of the unusual grafts. Two patients were RASG recipients, five patients were RPSG recipients, and three patients were Ext LLC recipients. All recipients and donors underwent a detailed investigation of the liver anatomy. We gathered information on recipients' and donors' laboratory findings, graft survival, and complications. The unusu-al and conventional graft groups were matched in 1:2, using propensity-score matching.
Results
The mean model for end-stage liver disease score of the unusual graft recipients was 18 and the mean graft-to-recipi-ent weight ratio was 0.8. ABO blood groups were characterized as incompatible in four cases. All laboratory findings of both the recipients and the donors indicated a downward trend. The survival rates of the unusual graft and the conventional grafts were not statistically different. The major complication rate of unusual graft recipients was similar to the rate of conventional graft recipients. Just like the recipients, the complication of the donor from the unusual graft did not differ from the conventional graft donors.
Conclusions
Even though the unusual grafts have a complicated indication, they will ensure improved donor safety and may provide feasible surgical outcomes to recipients.