Technical refinement preserving segment 4 to donor in extended right hepatectomy.

BACKGROUND/AIMS: Donor extended right hepatectomy, including the middle hepatic vein (MHV) and a part of segment 4 (Sg4), is performed to overcome inadequate graft for large adult recipient as resolving congestion of right anterior section. However, using this technique remnant donor liver is often too small. Here, we introduce a technical Modified extended right hepatectomy (MERH), in which the MHV was excavated preserving the entire Sg4 in the donor.

METHODOLOGY

We compared clinical outcomes between donors using our technique (n=12) that may result in Sg4 congestion, and right hepatectomy (RH, n=12) that may not. MERH was performed when the remnant donor liver had a volume exceeding 35% and showed no steatosis in preoperative imaging study.

RESULTS

No donor died, and there were no differences in operative time and postoperative recovery between the two groups (p>0.05). The regeneration of the remnant liver after MERH and RH were similar (160.2% vs. 187.7% at POD 10; 222.2% vs. 230.5% at 4 months) (p>0.05).

CONCLUSIONS

Our results show that MERH didn't impair recovery or liver regeneration in donors, and indicate that MERH will be useful in adult living donor liver transplantation.