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Right anterior section graft for living-donor liver transplantation: A case report

 Jonathan Geograpo Navarro  ;  Gi Hong Choi  ;  Myoung Soo Kim  ;  Yoon Bin Jung  ;  Jae Geun Lee 
 MEDICINE, Vol.98(19) : e15212, 2019 
Journal Title
Issue Date
Adult ; Alcoholism/complications ; Family ; Humans ; Liver/diagnostic imaging ; Liver/surgery ; Liver Cirrhosis, Alcoholic/diagnostic imaging ; Liver Cirrhosis, Alcoholic/surgery* ; Liver Transplantation*/methods ; Living Donors* ; Male ; Middle Aged
RATIONALE: In living-donor liver transplantation (LDLT), the right lobe graft is commonly utilized to prevent small-for-size syndrome, despite the considerable donor morbidity. Conversely, the feasibility of the left lobe graft and the right posterior section graft in smaller-sized recipients is now commonly employed with comparable outcomes to right lobe grafts. The efficacy of the right anterior section graft has rarely been reported. PATIENT CONCERNS: A 56-year-old man, a heavy alcoholic beverage drinker for 20 years, presented in the emergency department with massive ascites and lethargy. He was previously admitted twice due to bleeding esophageal varices. DIAGNOSIS: He was diagnosed with hepatic encephalopathy coma due to alcoholic liver cirrhosis. The Child-Turcotte-Pugh score was 11 (class C), and the Model for End-stage Liver Disease score was 21.62. INTERVENTION: A LDTL was offered to the patient as the best treatment option available. The patient's 26-year-old son was found to be the only donor-compatible candidate for the LDTL.Preoperatively, the right lobe of the donor occupied 76.2% of the total liver volume exposing the donor to a small residual liver volume. The right posterior section and left lobe volumes were insufficient, providing a graft-to-recipient weight ratio of 0.42% and 0.38%, respectively. However, the right anterior section could fulfill an acceptable GRWR of 0.83%. Thus, a living donor right anterior sectionectomy was performed. OUTCOMES: Clinical signs and symptoms and liver function improved following anterior section graft transplantation without complications. LESSON: The procurement of anterior section graft is technically feasible in selected patients, especially in high-volume liver centers.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Lee, Jae Geun(이재근) ORCID logo https://orcid.org/0000-0002-6722-0257
Jung, Yoon Bin(정윤빈)
Choi, Gi Hong(최기홍) ORCID logo https://orcid.org/0000-0002-1593-3773
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