A comparison of right and left lobectomies for living donor liver transplantation: an anesthesiologist's point of view

Right Lobe Versus Left Lobe Living Donor Liver Transplantation: A Systematic Review and Meta-analysis of Donor and Recipient Outcomes

BACKGROUND

Living donor liver transplantation (LDLT) is an established treatment for advanced liver disease. Whether right lobe (RL) or left lobe (LL) LDLT provides the best outcomes for donors and recipients remains contentious.

METHODS

MedLine, Embase, PubMed, and Cochrane Central were searched to identify studies comparing RL- and LL-LDLT and reporting donor and/or recipient outcomes. Effect sizes were pooled using random-effect meta-analysis. Meta-regressions were used to explore heterogeneity.

RESULTS

Sixty-seven studies were included. RL donors were more likely to experience major complications (relative risk [RR] = 1.63; 95% confidence interval [CI] = 1.30-2.05; I2 = 19%) than LL donors; however, no difference was observed in the risk of any biliary complication (RR = 1.41; 95% CI = 0.91-2.20; I2 = 59%), bile leaks (RR = 1.56; 95% CI = 0.97-2.51; I2 = 52%), biliary strictures (RR = 0.99; 95% CI = 0.43-1.88; I2 = 27%), or postoperative death (RR = 0.51; 95% CI = 0.25-1.05; I2 = 0%). Among recipients, the incidence of major complications (RR = 0.85; 95% CI = 0.68-1.06; I2 = 21%), biliary complications (RR = 1.10; 95% CI = 0.91-1.33; I2 = 8%), and vascular complications (RR = 0.79; 95% CI = 0.44-1.43; I2 = 0%) was similar. Although the rate of small for size syndrome (RR = 0.47; 95% CI = 0.30-0.74; I2 = 0%) and postoperative deaths (RR = 0.62; 95% CI = 0.44-0.87; I2 = 0%) was lower among RL-LDLT recipients, no differences were observed in long-term graft (hazard ratio = 0.87; 95% CI = 0.55-1.38; I2 = 74%) and overall survival (hazard ratio = 0.86; 95% CI = 0.60-1.22; I2 = 44%).

CONCLUSIONS

LL donors experience fewer complications than RL donors, and LL-LDLT recipients had similar outcomes to RL-LDLT recipients. These findings suggest that LL-LDLT offers the best outcomes for living donors and similar outcomes for recipients when measures are taken to prevent small for size syndrome.

Gender Imbalance and the Relationship Between Living Donors and Recipients in Liver Transplantations in an Organ Transplant Center in Turkey

OBJECTIVES

Because of the scarcity of publications on gender differences and the relationship between living donors and recipients in liver transplant procedures, we carried out this study with the objective to examine the gender distribution of donors and recipients and the relationships between donors and recipients in living related-donor liver transplants performed in a university hospital in Ankara, Turkey.

MATERIALS AND METHODS

We retrospectively evaluated the data of 549 patients who underwent living related-donor and deceased-donor liver transplant procedures conducted in a university hospital between 1988 and 2017 and the 409 living donors.

RESULTS

Males constituted 53.1% of the 409 living related liver donors and 63.6% of the living liver recipients. We found that 72.9% of the deceased-donor liver transplant recipients were also male. Of living related donors, 91.4% were blood relatives, with 74.8% being first-degree relatives. The most common donor-recipient relation was mother to son. Analyses of interspousal donations showed a significant difference between husband to wife and vice versa (7 vs 17; P < .05).

CONCLUSIONS

Most recipients and donors in living related-donor liver transplants were males with a young predominance. It is not known whether this might be related to biologic, psychologic, or socio cultural features of patients, gender issues, or economic factors. Further research with qualitative components on the influential factors, including gender, is needed.

Differences in Perioperative Outcomes Between Right and Left Hepatic Lobectomy

The safety of hepatic resection is well documented, but outcome studies comparing right and left hepatic lobectomy are sparse, especially in the context of malignancy. This study analyzes the differences in outcomes between right and left hepatic lobectomy in patients with malignant diagnoses. All patients undergoing right and left hepatic lobectomies for malignancy were extracted from the National Surgical Quality Improvement Program (NSQIP) database (2005-2010). The data was analyzed to determine differences in perioperative mortality and morbidity between the two groups. A total of 1680 patients who underwent right or left hepatic lobectomy for malignant diagnoses were identified. Patients undergoing right hepatic lobectomy had a four-fold increase in perioperative mortality, compared to left lobectomy (p < 0.0001). Mortality in right lobectomy patients increased incrementally with age, with a 12-fold increase in patients > 81 years of age. Patients undergoing right lobectomy also experienced a statistically significant increase in morbidity involving several systems (infectious, pulmonary, cardiac and renal). The results of our study demonstrate that patients undergoing right hepatic lobectomy for malignancy experience a significantly higher incidence of mortality and multi-system morbidity when compared to left lobectomy. This information will be crucial for pre-operative risk-stratification of patients undergoing hepatic resection for malignancy.