Use of a Right Lateral Sector Graft in Living Donor Liver Transplantation is Feasible, but Special Caution Is Needed With Respect to Liver Anatomy

T. Kokudo; K. Hasegawa; J. Arita; S. Yamamoto; J. Kaneko; N. Akamatsu; Y. Sakamoto; M. Makuuchi; Y. Sugawara; N. Kokudo


American Journal of Transplantation. 2016;16(4):1258-1265. 

In This Article

Abstract and Introduction


Right lateral sector (RLS) grafting has been introduced to enlarge the potential donor pool for living donor liver transplantation (LDLT); however, evidence of its feasibility is limited. Data from 437 LDLTs carried out between 2000 and 2013 were analyzed retrospectively. LDLTs using a right liver graft (n = 251) were compared with those using a RLS graft (RLSG; n = 28). No donor mortality occurred, and the major complication rates were similar between the two groups. Postoperative liver function preservation was better in the RLSG donors. Concerning the recipients, the mortality and overall survival rates were similar between the two groups. The complication rate for the recipients was higher when more than two arterial or biliary anastomoses were necessary. A systematic literature search identified four reports on LDLT using RLSGs. Among 66 LDLTs, including the present series, there were no cases of donor death, and the rates of major and minor complications in the donors were 6% and 29%, respectively. The major complication and overall mortality rates in the recipients were 29% and 6%, respectively. LDLT using an RLSG is feasible, with an acceptable survival rate among the recipients.


Living donor liver transplantation (LDLT) is widely performed, especially in countries in which deceased donors are scarce.[1,2] Left liver grafts (LLGs) were initially used in adult LDLT in the 1990s in consideration of the donors' safety.[3] Subsequently, to meet the metabolic demand of adult recipients, right liver graft (RLG) procurement started to be performed.[4] RLGs have become the standard choice because of the advantage with respect to graft volume.[5] The right liver (RL) volume, however, accounts for ≈60–75% of the total liver volume, and a relatively high frequency of donor mortality and acute liver failure has been reported for RLG donors.[6] Consequently, selection of an RLG is not considered suitable for donors with a large RL, that is, RL volume accounting for >70% of the total liver volume.[7]

To overcome this restriction, our group began to use right lateral sector grafts (RLSGs) when use of a hemiliver graft (i.e. RLG or LLG) was not feasible.[8,9] After our initial report, several specialized centers began to carry out RLSG procurement for LDLT;[10,11] however, because of the relatively rare indication and the technical difficulties of RLSG procurement, technical tips and evidence concerning its feasibility are still insufficient. In this study, we reported the largest experience of RLSG use in LDLT and evaluated the feasibility of this relatively new technique through a systematic review of the literature.