ORIGINAL RESEARCH
Transpl. Int.
Volume 38 - 2025 | doi: 10.3389/ti.2025.14606
This article is part of the Special IssueOncology and Solid Organ Transplantation: New Biological and Clinical InsightsView all 12 articles
A 20-year single center experience of right lateral sector graft in adult living donor liver transplantation with special reference to biliary complication
Tomoaki HayakawaNobuhisa AkamatsuTakashi KokudoKyoji ItoYujiro NishiokaYujiro MiharaAkihiko IchidaTakeshi TakamotoYoshikuni Kawaguchi
Kiyoshi Hasegawa*- Hepato-Biliary-Pancreatic Surgery Division, The University of Tokyo Hospital, Tokyo, Japan
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Background: Right lateral sector grafts (RLSGs) in living donor liver transplantation (LDLT) expand donor options, however, their long-term outcomes and complication rates remain unclear.Study Design: We analyzed 661 LDLTs (42 RLSGs, 363 right liver grafts, 243 left liver grafts, and 13 left lateral section grafts) performed between 2000 and 2021 at the University of Tokyo Hospital. Results: RLSG donors experienced a 4.8% major complication (Clavien-Dindo grade ≥3b) rate with no mortality. RLSG recipients had a 38.1% major complication rate and a 9.5% 90-day mortality rate. Compared with other graft types, RLSG recipients had higher rates of hepatic artery thrombosis (9.5% vs. 3.1%), portal vein stenosis (14.3% vs. 1.9%), and biliary stricture (42.9% vs. 16.3%). The 5-year survival rate for RLSG recipients (79.2%) did not differ significantly from other graft types (84.7%). Graft bile ducts measuring >4 mm were associated with increased anastomotic biliary stricture. RLSG, the only option for 33 recipients, expanded the donor pool by 5%.Conclusions: Although RLSG is associated with higher vascular and biliary complication rates, it demonstrates favorable long-term survival and significantly expands the donor pool. For patients without suitable conventional graft options, RLSG represents a viable choice that provides life-saving transplantation opportunity.
Keywords: biliary stricture, living donor liver transplantation (LDLT), right lateral sector graft, donor pool expansion, vascular complication
Received: 11 Mar 2025; Accepted: 10 Jun 2025.
Copyright: © 2025 Hayakawa, Akamatsu, Kokudo, Ito, Nishioka, Mihara, Ichida, Takamoto, Kawaguchi and Hasegawa. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Kiyoshi Hasegawa, Hepato-Biliary-Pancreatic Surgery Division, The University of Tokyo Hospital, Tokyo, Japan
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