Auxiliary two-staged partial resection (ASPIRE) LTx for end-stage liver disease to avoid small-for-size situations

Question Patients with end-stage liver disease and low MELD scores have limited chances to receive deceased donor livers and therefore require consideration of living liver donation. In this setting donor safety is essential. Donor risks are lower in case of a left liver donation because a larger volume of liver remains in the donor. However, due to lower graft volume, the risk for a small-for-size situation in the recipient may increase. This study aims to prevent small-for-size situations in the recipient using an auxiliary two-staged partial resection liver transplantation of living-donated left liver lobes.

Methods Two patients received a two-stage auxiliary liver transplantation using living-donated left liver lobes after left lateral liver resection. The native extended right liver was removed in a second operation after sufficient hypertrophy of the left liver graft had occurred.

Results No donor developed postoperative complications. In both recipients the graft volume increased by an average of 105 % (329ml to 641ml), from graft-to-body-weight ratio of 0.54 to 1.08 within 11 days after transplantation, so that the remnant native right liver could be removed. No recipient developed small-for-size syndrome, and after a follow-up time of 25 months graft function and overall condition is good in both recipients.

Conclusions Auxiliary two-staged partial resection liver transplantation using living-donor left lobes is technically feasible and can prevent small-for-size situation in adults/adolescents. This new technique can expand the potential living-donor pool, and in selected recipient/donor combinations enables a living liver donation and contributes to increase donor safety.

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Artikel online veröffentlicht:
04. Januar 2021