Indications and recipient outcomes of adult left lobe living donor liver transplantation.

Adult left lobe living donor liver transplantation has long been practiced nearly exclusively in Japan. To overcome the potential risks of small-for-size syndrome and hepatic venous outflow obstruction associated with the use of left lobe grafts, center-specific countermeasures such as splenectomy, meticulous hepatic venous reconstruction, and inclusion of the caudate lobe have been implemented, resulting in short- and long-term results comparable with those of right lobe graft in high-volume centers. A recent systematic review and meta-analysis confirmed these observations; however, the indications and techniques of adult left lobe living donor liver transplantation have yet to be standardized. Recently, there is a growing momentum in the Western countries toward adult left lobe living donor liver transplantation to expand the donor pool in an era of severe organ scarcity and decrease waitlist mortality rates. The introduction of minimally invasive living-donor hepatectomy is expected to further facilitate the use of left lobe grafts.