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

Abstract

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. Abbreviations: CT = computed tomography, GWRW = graft-to-recipient weight ratio, INR = international normalized ratio, LDLT = living-donor liver transplantation, LHA = left hepatic artery, LHD = left hepatic duct, LPV = left portal vein, MRI = magnetic resonance imaging, PPA = proper hepatic artery, PV = portal vein, RAHA = right anterior hepatic artery, RAHA = right anterior hepatic duct, RAPV = right anterior portal vein, RHA = right hepatic artery, RPHA = right posterior hepatic artery, RPHA = right posterior hepatic duct, RPPV = right posterior portal vein, RPV = right portal vein, SFSS = small-for-size graft syndrome, SGOT = serum lutamic-oxaloacetic transaminase SGPT = serum lutamic ruvic transaminase