• Santiago Sánchez-Cabús, Daniel Cherqui, Niki Rashidian, Gabriella Pittau, Laure Elkrief, Aude Vanlander, Christian Toso, Constantino Fondevila, Antonio Sa Cunha, Thierry Berney, Denis Castaing, Bernard de Hemptinne, Josep Fuster, Xavier Rogiers, René Adam, Pietro Majno, Juan Carlos García-Valdecasas, and Roberto I Troisi.
• Department of HPB Surgery and Transplantation, Hospital Clínic de Barcelona. CIBEREHD. Barcelona, Spain.
• Ann. Surg. 2018 Nov 1; 268 (5): 876-884.

ObjectiveTo evaluate the European experience after Adult-to-adult living donor liver transplantation using the left liver (LL-aLDLT).Summary Background DataLL-aLDLT decreases donor risk but provides a smaller graft that increases recipient risk as compared with right liver (RL-aLDLT). However, there is little knowledge of results obtained after LL-aLDLT in Europe.MethodsThis is a European multicenter retrospective study which aims to analyze donor and recipient outcomes after 46 LL-aLDLT.ResultsSeventy-six percent of the grafts were harvested by minimally invasive approach. Mean donor hospital stay was 7.5 ± 3.5 days. Donor liver function was minimally impaired, with 36 donors (78.3%) without any 90-day complication, and 4 (8.7%) presenting major complications. One, 3, and 5-year recipient survival was 90.9%, 82.7%, and 82.7%, respectively. However, graft survival was of 59.4%, 56.9%, and 56.9% at 1, 3, and 5 years respectively, due to a 26.1% urgent liver retransplantation (ReLT) rate, mainly due to SFSS (n = 5) and hepatic artery thrombosis (HAT, n = 5). Risk factor analysis for ReLT and HAT showed an association with a graft to body weight ratio (GBWR) <0.6% (P = 0.01 and P = 0.024, respectively) while SFSS was associated with a recipient MELD ≥14 (P = 0.019). A combination of donor age <45 years, MELD <14 and actual GBWR >0.6% was associated with a lower ReLT rate (0% vs. 33%, P = 0.044).ConclusionsOur analysis showed low donor morbidity and preserved liver function. Recipient outcomes, however, were hampered by a high ReLT rate. A strict selection of both donor and recipients is the key to minimize graft loss.

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