Liver lobe graft side and outcomes in living-donor liver transplant with small-for-size grafts

Objectives: Living-donor liver transplant with smallfor- size grafts (graft-to-recipient weight ratio < 0.8) may provide satisfactory results. We compared outcomes between right and left donor lobe in living-donor liver transplant. Materials and Methods: Patients who had livingdonor liver transplant from 2006 to 2008 with graftto- recipient weight ratio < 0.8 (graft: right lobe, 24 patients; left lobe, 26 patients) were reviewed retrospectively. Results: There were no significant differences in demographic and preoperative clinical data between patients who received a right or left lobe liver graft. Duration of surgery was longer, cold ischemia time was shorter, and mean baseline portal vein flow was greater in transplants performed with left than right donor lobes. Portal vein flow modulation with splenectomy was performed when portal flow was > 250 mL/min/100 g graft. Small-forsize syndrome was observed in 6 recipients (14%), but no patient who developed small-for-size syndrome developed liver failure or required revision transplant. The frequency of small-for-size syndrome was significantly greater in patients who had left lobe (4 patients [15%]) than right lobe transplant (2 patients [8%]; P ≤.05). Graft dysfunction-free survival was significantly greater with right than left lobe grafts. In multivariate analysis, graft side was the only significant risk factor for small-for-size syndrome. Conclusions: In patients having living-donor liver transplant with small-for-size grafts, outcome was better with right than left lobe grafts.