Right versus left donor hepatectomy in living donor liver transplantation

Living donor liver transplantation (LDLT) requires careful graft selection to achieve optimal recipient outcomes while maintaining donor safety.Right lobe (RL) and left lobe (LL) grafts each have distinct anatomical, technical, and physiological characteristics that influence perioperative management and postoperative outcomes.Historically, RL grafts have been more commonly used because of their larger graft volume and lower risk of small-for-size syndrome, whereas LL grafts may provide advantages in donor safety because of greater remnant liver volume.This review summarizes current evidence comparing right and left donor hepatectomy in adult LDLT, focusing on anatomical and technical considerations, donor safety, and recipient outcomes.We discuss key differences in vascular and biliary anatomy, venous outflow reconstruction, and portal hemodynamics, as well as contemporary strategies such as portal inflow modulation and refined recipient selection that have enabled broader application of LL grafts.Current evidence suggests that both graft types can achieve acceptable outcomes when appropriately selected and managed.Therefore, graft selection in adult LDLT should be individualized according to donor anatomy, recipient condition, graft size, and institutional expertise.Further studies are needed to refine graft selection strategies and optimize both donor and recipient outcomes in contemporary LDLT practice.