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Pure laparoscopic full-left living donor hepatectomy for calculated small-for-size LDLT in adults: proof of concept

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Abstract
Adult-to-adult living donor liver transplantation (A2ALDLT) is an accepted mode of treatment for end-stage liver disease. Right-lobe grafts have usually been preferred in view of the higher graft volume, which lowers the risk of a small-for-size syndrome. However, donor left hepatectomy is associated with less morbidity than when it is compared to right hepatectomy. Laparoscopic donor hepatectomy (LDH) has been considered almost exclusively in pediatric transplantation. The results of laparoscopic left-liver graft procurement for calculated small-for-size A2ALDLT in four donors are presented. The graft-to-recipient body weight ratio was <0.8 in all recipients. The mean portal vein flow and the pressure and hepatic artery flows were measured at 190 +/- 56mL/min/100g, 13 +/- 1.4mm/Hg and 109 +/- 19mL/min, respectively. No early postoperative donor complications were recorded. One graft was lost due to intrahepatic abscesses. Asymptomatic stenosis of a right posterior duct was treated with a Roux-en-Y loop 4 months later in one donor. We show that LDH of the full-left lobe is feasible. LDH is a very demanding operation, potentially decreasing donor morbidity. Standardization of this procedure, making it accessible to the growing number of experienced laparoscopic liver surgeons, could help renewing the interest for A2ALDLT in the Western world.
Keywords
Laparoscopic liver donor hepatectomy, living donor liver transplantation, portal vein pressure, small-for-size grafts, transit time flow measurement, LIVER-TRANSPLANTATION, INFLOW MODULATION, HYBRID METHOD, SINGLE-CENTER, GRAFT, PRESSURE, SAFETY

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Chicago
Troisi, Roberto, M Wojcicki, Federico Tomassini, PHILIPPE HOUTMEYERS, Aude Vanlander, Frederik Berrevoet, Peter Smeets, Hans Van Vlierberghe, and Xavier Rogiers. 2013. “Pure Laparoscopic Full-left Living Donor Hepatectomy for Calculated Small-for-size LDLT in Adults: Proof of Concept.” American Journal of Transplantation 13 (9): 2472–2478.
APA
Troisi, R., Wojcicki, M., Tomassini, F., HOUTMEYERS, P., Vanlander, A., Berrevoet, F., Smeets, P., et al. (2013). Pure laparoscopic full-left living donor hepatectomy for calculated small-for-size LDLT in adults: proof of concept. AMERICAN JOURNAL OF TRANSPLANTATION, 13(9), 2472–2478.
Vancouver
1.
Troisi R, Wojcicki M, Tomassini F, HOUTMEYERS P, Vanlander A, Berrevoet F, et al. Pure laparoscopic full-left living donor hepatectomy for calculated small-for-size LDLT in adults: proof of concept. AMERICAN JOURNAL OF TRANSPLANTATION. 2013;13(9):2472–8.
MLA
Troisi, Roberto, M Wojcicki, Federico Tomassini, et al. “Pure Laparoscopic Full-left Living Donor Hepatectomy for Calculated Small-for-size LDLT in Adults: Proof of Concept.” AMERICAN JOURNAL OF TRANSPLANTATION 13.9 (2013): 2472–2478. Print.
@article{4142213,
  abstract     = {Adult-to-adult living donor liver transplantation (A2ALDLT) is an accepted mode of treatment for end-stage liver disease. Right-lobe grafts have usually been preferred in view of the higher graft volume, which lowers the risk of a small-for-size syndrome. However, donor left hepatectomy is associated with less morbidity than when it is compared to right hepatectomy. Laparoscopic donor hepatectomy (LDH) has been considered almost exclusively in pediatric transplantation. The results of laparoscopic left-liver graft procurement for calculated small-for-size A2ALDLT in four donors are presented. The graft-to-recipient body weight ratio was {\textlangle}0.8 in all recipients. The mean portal vein flow and the pressure and hepatic artery flows were measured at 190 +/- 56mL/min/100g, 13 +/- 1.4mm/Hg and 109 +/- 19mL/min, respectively. No early postoperative donor complications were recorded. One graft was lost due to intrahepatic abscesses. Asymptomatic stenosis of a right posterior duct was treated with a Roux-en-Y loop 4 months later in one donor. We show that LDH of the full-left lobe is feasible. LDH is a very demanding operation, potentially decreasing donor morbidity. Standardization of this procedure, making it accessible to the growing number of experienced laparoscopic liver surgeons, could help renewing the interest for A2ALDLT in the Western world.},
  author       = {Troisi, Roberto and Wojcicki, M and Tomassini, Federico and HOUTMEYERS, PHILIPPE and Vanlander, Aude and Berrevoet, Frederik and Smeets, Peter and Van Vlierberghe, Hans and Rogiers, Xavier},
  issn         = {1600-6135},
  journal      = {AMERICAN JOURNAL OF TRANSPLANTATION},
  language     = {eng},
  number       = {9},
  pages        = {2472--2478},
  title        = {Pure laparoscopic full-left living donor hepatectomy for calculated small-for-size LDLT in adults: proof of concept},
  url          = {http://dx.doi.org/10.1111/ajt.12362},
  volume       = {13},
  year         = {2013},
}

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