The changes of the medial right lobe, transplanted with left lobe liver graft from living donors

Background. Procurement of left lobe (LL) living donor graft with medial right lobe (mRL) might be an innovative technique. Methods. The grafts were procured from a living donor, exposing the right anterior Glissonean pedicles, after confirmation of the demarcation line by test-clamping of the right Glissonean pedicle. Based on serial computed tomography, the increase in the graft volume (GV) after addition of mRL and changes in volumes were evaluated. Results. The addition of mRL (n=7) increased GV by 48±9 g, which corresponded to a 4% increase in GV-to-standard liver volume ratio. After transplantation, mRL volume has increased in all cases. The regeneration rate of the mRL and other LL segments 1 month after transplantation was 61%±18% and 146%±15%, respectively. Viable hepatic parenchyma with marginal bile duct dilatations in transplanted mRL was observed in all the cases. Marginal enhancement was observed in those cases with promoted regeneration of transplanted mRL. In the cranial part of the mRL, portal branching from the left portal vein, over the middle hepatic vein, was observed in all cases. Conclusion. This technique affords an increase in GV in living donor LL procurement, and should increases the application of LL grafts in living donor liver transplantation.