Introduction
Patients and methods
Patients
Graft selection
Donor 1 | Donor 2 | Donor 3 | Donor 4 | Donor 5† | Donor 6 | Donor 7‡ | Donor 8* | Donor 9 | Donor 10 | |
---|---|---|---|---|---|---|---|---|---|---|
Total liver volume, ml | 1538 | 1823 | 1260 | 2015 | 1111 | 1721 | 1560 | 1425 | 2808 | 1265 |
Modified right lobe | ||||||||||
Graft volume, ml | 1102.0 | 1381.0 | 960 | 1425.0 | 798.0 | 1249.0 | 988.4 | 1080.0 | 2075.0 | 890.0 |
Residual volume, % | 28.3 | 24.2 | 23.8 | 29.3 | 28.2 | 27.4 | 36.6 | 24.2 | 26.1 | 29.6 |
GRWR | 1.6 | 1.6 | 1.2 | 2.0 | 1.9 | 2.4 | 1.5 | 1.5 | 3.0 | 1.6 |
Extended left liver plus caudate lobe | ||||||||||
Graft volume, ml | 436.0 | 442.0 | 300 | 590.0 | 313.0 | 472.0 | 571.6 | 345.0 | 733.0 | 375.0 |
Residual volume, % | 71.7 | 75.8 | 71.8 | 70.7 | 71.8 | 72.6 | 63.4 | 75.8 | 73.9 | 70.4 |
GRWR | 0.6 | 0.5 | 0.38 | 0.8 | 0.7 | 0.9 | 0.9 | 0.5 | 1.1 | 0.7 |
Right posterior section | ||||||||||
Graft volume, ml | 734.0 | 678.0 | 304.0 | 430.0 | 357.0 | 636.0 | 480.0 | 523.1 | 910.6 | 551.0 |
Residual volume, % | 52.3 | 62.8 | 75.8 | 78.7 | 67.9 | 63 | 69.2 | 63.3 | 67.6 | 56.4 |
GRWR | 1.0 | 0.8 | 0.42 | 0.6 | 0.9 | 1.2 | 0.7 | 0.8 | 1.3 | 1.0 |
Right anterior section | ||||||||||
Graft volume, ml | 368.0 | 703.0 | 655.0 | 995.0 | 441.0 | 613.0 | 508.4 | 556.9 | 1164.4 | 339.0 |
Residual volume, % | 76.1 | 61.4 | 48.0 | 50.6 | 60.3 | 64.4 | 67.4 | 60.9 | 58.5 | 73.2 |
GRWR | 0.5 | 0.8 | 0.83 | 1.4 | 1.1 | 1.2 | 0.8 | 0.8 | 1.7 | 0.6 |
Anatomical variance | ||||||||||
Portal vein | Type 3 | Type 3 | Type 3 | Type 1 | Type 1 | Type 1 | Type 2 | Type 2 | Type 1 | Type 3 |
Hepatic artery | Extrahepatic bifurcation of right HA | Extrahepatic bifurcation of right HA | Early bifurcation of left HA | Extrahepatic bifurcation of right HA | Early bifurcation of left HA | Early bifurcation of left HA | Extrahepatic bifurcation of right HA | A4 from right HA | Extrahepatic bifurcation of right HA | |
Bile duct | Right posterior duct drains into left duct |
Right anterior section graft (Fig. 2A)
Suitable anatomy
Donor graft sectionectomy
Recipient surgery
Right posterior section graft (Fig. 2B)
Suitable anatomy
Donor graft sectionectomy
Recipient surgery
Extended left liver plus caudate lobe graft (Fig. 2C)
Suitable anatomy
Donor graft lobectomy
Recipient surgery
Postoperative outcomes
Statistical analysis
Results
Patients and grafts
Case 1 | Case 2 | Case 3 | Case 4 | Case 5 | Case 6 | Case 7 | Case 8 | Case 9 | Case 10 | |
---|---|---|---|---|---|---|---|---|---|---|
Recipient | ||||||||||
Sex | Male | Male | Male | Male | Female | Female | Female | Male | Male | Male |
Age | 61 | 48 | 56 | 51 | 13 | 71 | 58 | 58 | 65 | 62 |
Height, cm | 161 | 173 | 174 | 172 | 146 | 159 | 143 | 173 | 166.7 | 164 |
Weight, kg | 68 | 84.7 | 76 | 71 | 42 | 51 | 65 | 70 | 69.4 | 57 |
BMI | 26.23 | 28.3 | 25.1 | 24 | 19.7 | 20.17 | 31.79 | 23.39 | 24.97 | 21.18 |
Etiology | HBV HCC | HBV HCC | Alcohol | HBV | AIH | HBV HCC | HBV HCC | HBV HCC | HCV Alcohol HCC | HBV HCC |
MELD score | 17 | 14 | 20 | 32 | 13 | 11 | 8.85 | 11 | 13 | 9 |
ABO type | O | O | O | A | A | A | A | B | B | AB |
Operation time, min | 812 | 639 | 497 | 650 | 625 | 590 | 1134 | 514 | 456 | 411 |
Estimated blood loss, mL | 2100 | 8150 | 4200 | 7300 | 3100 | 5800 | 15,500 | 6900 | 4000 | 5000 |
Postoperative hospital stay, days | 35 | 22 | 15 | 36 | 28 | 23 | 12† | 35 | 23 | 19 |
Postoperative Outcomes | ||||||||||
Primary non-function | No | No | No | No | No | No | No | No | No | No |
Small-for-size syndrome | No | No | No | No | No | No | Yes | No | No | No |
HA complication | No | No | No | No | Yes | No | No | No | No | No |
Biliary complication | No | Yes | No | Yes | Yes | No | No | Yes | No | No |
180-day mortality | No | No | No | No | No | No | Yes | No | No | No |
Donor | ||||||||||
Sex | Male | Male | Male | Male | Male | Male | Male | Male | Male | Male |
Age | 34 | 44 | 26 | 48 | 45 | 42 | 52 | 39 | 33 | 33 |
Height, cm | 171 | 186 | 177 | 175 | 170 | 165 | 158 | 175 | 180 | 178 |
Weight, kg | 69 | 85 | 83 | 82 | 68 | 55 | 76 | 76 | 87 | 71.3 |
BMI | 23.6 | 24.57 | 26.49 | 26.77 | 23.52 | 20.2 | 30.44 | 24.82 | 26.85 | 22.5 |
ABO type | O | B | O | O | B | AB | O | A | B | B |
Operation time, min | 352 | 283 | 385 | 535 | 285 | 408 | 464 | 313 | 271 | 265 |
Estimated blood loss, mL | 300 | 450 | 150 | 250 | 100 | 800 | 300 | 600 | 300 | 300 |
Postoperative hospital stay, days | 14 | 7 | 8 | 8 | 9 | 8 | 7 | 8 | 7 | 8 |
Estimated remnant liver volume, % | 49.3 | 61.03 | 47.9 | 67.27 | 67.38 | 70.79 | 61.02 | 54.8 | 51.3 | 55.9 |
Graft | ||||||||||
Type, selected | RPG | RPG | RAG | Ext LLC | RAG | Ext LLC | Ext LLC | RPG | RPG | RPG |
Estimated graft volume, mL | 734 | 678 | 655.8 | 590 | 357 | 472 | 571.6 | 523.1 | 910.6 | 551.0 |
Weight, g | 531 | 639 | 612 | 519 | 410 | 592 | 351 | 452 | 694 | 334 |
Estimated GRWR | 1.03 | 0.80 | 0.83 | 0.83 | 0.85 | 0.92 | 0.88 | 0.75 | 1.30 | 0.98 |
GRWR | 0.78 | 0.75 | 0.80 | 0.73 | 0.97 | 1.16 | 0.54 | 0.64 | 1.00 | 0.60 |
Before propensity-score matching | After propensity-score matching (all) | After propensity-score matching (right) | After propensity-score matching (left) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Conventional (n = 487) | Unusual (n = 10) | p-value | Conventional (n = 20) | Unusual (n = 10) | p-value | Rt. conventional (n = 14) | RAG, RPG (n = 7) | p-value | Lt. conventional (n = 6) | Ext. LLC (n = 3) | p-value | |
Recipient | ||||||||||||
Sex: female | 152(31.2) | 3(30) | 1.000 | 4(20) | 3(30) | 0.657 | 4(28.6) | 1(14.3) | 0.624 | 2(33.3) | 2(66.7) | 0.524 |
Age | 56.00 (50.00–61.00) | 57.00 (50.25–61.75) | 0.751 | 61.00 (52.25–63.75) | 57.00 (50.25–61.75) | 0.373 | 59.50 (56.75–65.00) | 56.00 (458.00–61.00) | 0.149 | 55.00 (46.50–63.75) | 58.00 (51.00–71.00) | 0.548 |
Height, cm | 167.00 (160.00–171.30) | 164.50 (155.75–173.25) | 0.711 | 169.00 (165.75–173.50) | 164.50 (155.75–173.25) | 0.448 | 163.00 (158.50–170.00) | 166.00 (161.000–174.00) | 0.400 | 167.15 (155.90–172.00) | 159.00 (143.00–172.00) | 0.714 |
Weight, kg | 67.00 (58.00–74.00) | 69.00 (55.50–72.25) | 0.949 | 70.50 (62.00–77.00) | 69.00 (55.50–72.25) | 0.286 | 68.00 (58.75–75.00) | 70.00 (57.00–76.00) | 0.913 | 60.50 (44.75–64.25) | 65.00 (51.00–71.00) | 0.262 |
BMI | 23.81 (21.97–26.16) | 24.55 (21.13–26.28) | 0.849 | 24.31 (21.72–25.73) | 24.55 (21.13–26.28) | 0.948 | 24.47 (23.29–26.29) | 25.10 (21.45–26.23) | 0.585 | 21.80 (15.94–23.02) | 24.00 (20.17–31.79) | 0.381 |
MELD score | 13.00 (10.00–19.00) | 13.00 (11.00–23.00) | 0.464 | 13.00 (11.00–19.50) | 13.00 (11.00–23.00) | 0.948 | 12.50 (8.75–22.00) | 13.00 (11.00–17.00) | 0.856 | 25.50 (16.75–31.50) | 32.00 (11.00–40.00) | 0.714 |
HTN | 113(23.2) | 1(10) | 0.467 | 6(30) | 1(10) | 0.372 | 4(28.6) | 0(0) | 0.255 | 1(16.7) | 1(33.3) | 1.000 |
DM | 127(26.1) | 1(10) | 0.465 | 3(15) | 1(10) | 1.000 | 3(21.4) | 0(0) | 0.521 | 3(50) | 1(33.3) | 1.000 |
HBV | 243(49.9) | 7(70) | 0.339 | 14(70) | 7(70) | 1.000 | 8(57.1) | 4(57.1) | 1.000 | 4(66.7) | 3(100) | 0.500 |
HCV | 27(5.5) | 2(20) | 0.111 | 1(5) | 2(20) | 0.251 | 1(7.1) | 1(14.3) | 1.000 | 0(0) | 1(33.3) | 0.333 |
HCC | 258(53.0) | 7(70) | 0.350 | 17(85) | 7(70) | 0.372 | 10(71.4) | 5(71.4) | 1.000 | 3(50) | 2(66.7) | 1.000 |
MILAN | 0.049 | 0.462 | 0.376 | 1.000 | ||||||||
Within Milan | 176(36.1) | 2(20) | 7(35) | 2(20) | 6(42.9) | 1(14.3) | 2(33.3) | 1(33.3) | ||||
Above Milan | 82(16.8) | 5(50) | 10(50) | 5(50) | 4(28.6) | 4(57.1) | 1(16.7) | 1(33.3) | ||||
Donor | ||||||||||||
Sex: female | 207(42.5) | 0(0) | 0.006 | 4(20) | 0(0) | 0.272 | 1(7.1) | 0(0) | 1.000 | 1(16.7) | 0(0) | 1.000 |
Age | 34.00 (25.00–42.00) | 38.50 (33.00–45.75) | 0.127 | 40.00 (32.50–48.75) | 38.50 (33.00–45.75) | 0.746 | 31.50 (24.50–44.25) | 34.00 (33.00–44.00) | 0.443 | 39.00 (32.00–50.75) | 48.00 (42.00–52.00) | 0.381 |
Height, cm | 170.00 (162.00–175.00) | 175.00 (168.75–178.50) | 0.072 | 172.00 (167.25–176.00) | 175.00 (168.75–178.50) | 0.475 | 178.00 (173.75–184.50) | 177.00 (170.00–180.00) | 0.856 | 169.50 (164.25–175.00) | 165.00 (158.00–175.00) | 0.548 |
Weight, kg | 65.00 (58.50–75.00) | 75.50 (68.75–83.50) | 0.012 | 70.00 (62.25–82.88) | 75.50 (68.75–83.50) | 0.397 | 75.50 (65.75–87.75) | 75.00 (69.00–85.00) | 0.585 | 78.50 (66.65–86.25) | 76.00 (55.00–82.00) | 0.548 |
BMI | 23.31 (21.36–25.23) | 24.53 (23.25–26.79) | 0.088 | 23.75 (22.42–25.66) | 24.53 (23.25–26.79) | 0.397 | 23.33 (21.94–26.03) | 24.49 (23.53–26.49) | 0.400 | 21.80 (15.94–23.02) | 26.78 (20.20–30.44) | 1.000 |
HTN | 11(2.3) | 0(0) | 1.000 | 0(0) | 0(0) | – | 1(7.1) | 0(0) | 1.000 | 1(16.7) | 0(0) | 1.000 |
DM | 1(0.2) | 0(0) | 1.000 | 0(0) | 0(0) | – | 1(7.1) | 0(0) | 1.000 | 0(0) | 0(0) | – |
Postoperative outcomes
Immediate outcomes
Survival (graft and patient survival)
Complications
Right conventional (n = 468) | RAG (n = 2) | RPG (n = 5) | Left conventional (n = 19) | Ext. LLC (n = 3) | p-value† | p-value‡ | p-value* | |
---|---|---|---|---|---|---|---|---|
Recipient complication | 0.834 | 0.38 | 0.33 | |||||
Grade 0 | 232(49.5) | 1(50) | 2(40) | 9(47.3) | 1(33.3) | |||
Grade I | 11(2.3) | 0(0) | 0(0) | 0(0) | 0(0) | |||
Grade II | 54(11.5) | 0(0) | 1(20) | 3(15.7) | 0(0) | |||
Grade IIIA | 135(28.8) | 1(50) | 2(40) | 6(31.5) | 1(33.3) | |||
Grade IIIB | 30(6.4) | 0(0) | 0(0) | 1(5.2) | 0(0) | |||
Grade IVA | 0(0) | 0(0) | 0(0) | 0(0) | 0(0) | |||
Grade IVB | 0(0) | 0(0) | 0(0) | 0(0) | 0(0) | |||
Grade V | 6(1.2) | 0(0) | 0(0) | 0(0) | 1(33.3) | |||
Overall complication | 254(54.2) | 1(50) | 3(60) | 13(68.4) | 2(66.6) | 1.000 | 1.000 | 1.000 |
Major complication, grade ≥ 3 | 173(36.9) | 1(50) | 2(40) | 9(47.3) | 2(66.6) | 0.714 | 1.000 | 0.513 |
Types of complication | ||||||||
Hepatic artery | 21(4.4) | 1(50) | 0(0) | 1(5.2) | 0(0) | 0.284 | 1.000 | 0.380 |
Hepatic vein | 29(6.1) | 0(0) | 0(0) | 0(0) | 0(0) | 1.000 | 1.000 | |
Portal vein | 14(2.9) | 0(0) | 0(0) | 0(0) | 1(33.3) | 0.136 | 0.266 | |
Bile duct | 127(27.1) | 1(50) | 2(40) | 4(21.0) | 1(33.3) | 0.398 | 1.00 | 0.471 |
Donor complication | 0.169 | |||||||
Grade 0 | 460(98.3) | 2(100) | 4(80) | 19(100) | 3(100) | |||
Grade I | 2(0.4) | 0(0) | 0(0) | 0(0) | 0(0) | |||
Grade II | 3(0.6) | 0(0) | 1(20) | 0(0) | 0(0) | |||
Grade IIIA | 3(0.6) | 0(0) | 0(0) | 0(0) | 0(0) |