Background: Adult-to-adult living donor liver transplantation (LDLT) has been widely performed as an alternative to the scarce liver grafts from deceased donors. Although most centers still prefer to choose the right liver graft (RLG) over the left liver graft (LLG), studies that reported favorable outcomes of LLGs are increasing. This study compared the clinical outcomes between LDLT using LLGs and RLGs with similar graft-to-recipient body weight ratios (GRWR).
Methods: This study analyzed data from a multicenter cohort using the Korean Organ Transplantation Registry. A total of 4,601 patients who underwent adult-to-adult LDLT were enrolled. After matching the Model for End-stage Liver Disease score and GRWR due to the different number of each group, the final cohort comprised 142 patients (25.1%) in the LLG group and 423 (74.9%) in the RLG group.
Results: For donors, the median age was higher in the LLG group than in the RLG group (34 [range, 16–62] vs. 30 [range, 16–66] years, P=0.002). Major complications occurred less frequently in the LLG group than in the RLG group (2 [1.4%] vs. 23 [5.4%], P=0.056). For recipients, the LLG group showed higher 90-day mortality (11 [7.7%] vs. 9 [2.1%], P=0.004) compared to the RLG group. The long-term graft survival was significantly worse in the LLG group (P=0.011). Multivariate analysis for graft survival revealed that the LLG group was not a significant risk factor (odds ratio, 1.01 [0.54–1.87]; P=0.980). Otherwise, donor age (>40; odds ratio, 2.18 [1.35–3.52]; P=0.001) and recipients' body mass index (<18.5 kg/m²; 2.98 [1.52–5.84], P=0.002) were independent risk factors for graft survival.
Conclusions: The short-term and long-term graft survival was worse in the LLG group compared to the RLG group. However, LLG was not an independent risk factor for graft survival in multivariate analysis. LLGs are still worth considering for selected donors and recipients regarding risk factors for graft survival.