Surgical Outcome of Right Liver Donors in Living Donor Liver Transplantation: Single-Center Experience with 500 Cases

• Published in: Journal of gastrointestinal surgery Vol. 16; no. 6; pp. 1160 - 1170
• Main Authors: Kim, Say-June, Na, Gun-Hyung, Choi, Ho-Joong, Yoo, Young-Kyung, Kim, Dong-Goo
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.06.2012; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Donor Selection; Endoscopy; Female; Follow-Up Studies; Gastroenterology; Hepatectomy; Humans; Length of Stay - trends; Liver; Liver Transplantation - methods; Liver Transplantation - mortality; Living Donors; Male; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Mortality; Original Article; Republic of Korea - epidemiology; Retrospective Studies; Risk Factors; Surgery; Surgical outcomes; Time Factors; Tissue and Organ Harvesting - methods; Tissue and Organ Harvesting - mortality; Treatment Outcome; Young Adult; Republic of Korea; South Korea; Hyperbilirubinemia; Biliary complication; Living donor liver transplantation; Donor right hepatectomy
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-012-1865-y

Background With the increasing number of living donor liver transplantation (LDLT), concerns regarding morbidity and mortality of donors have become inevitable. Thus, the aim of the present study was to find ways to reduce the rate of morbidity and mortality of donors by analyzing our experience. Methods A retrospective clinicopathologic analysis was performed for 500 consecutive living donors who underwent donor right hepatectomy between May 1999 and February 2011. We chronologically divided those procedures into three periods: period A ( n  = 100), period B ( n  = 200), and period C ( n  = 200). Surgical outcomes according to each period were then compared. Results Over time, the following factors have decreased: the operative time, the amount of transfusions during surgery, hospital stay, and the incidence of biliary complications. No mortality developed. Even though the total complication rate was high (21.6 %, n  = 108) including 10.6 % ( n  = 53) of biliary complications, the grade 3 complication rate was only 9.4 % ( n  = 47). In most patients with grade 3 complication, interventional therapies via radiologic or endoscopic approaches corrected these complications, and reoperation was required for ten patients (2 %). Whereas biliary complications were related with operation period (period B or C compared to period A; relative risk [RR] 2.10, P  = 0.049, 95 % CI 1.01–4.39) and operative time (RR 1.01, P  = 0.027, 95 % CI 1.00–1.02), postoperative hyperbilirubinemia (serum total bilirubin ≥ 5 mg/dL) was related with male gender (RR 2.68, P  = 0.039, 95 % CI 1.05–6.85) and ≥ 25 % liver steatosis (RR 3.35, P  = 0.053, 95 % CI 0.99–11.38). Conclusions Optimization of donor selection as well as institutional experience is imperative to improve the surgical outcome. Even though donor hepatectomy was associated with relatively higher complication rate, most complications showed low-grade severity which could be corrected by interventional therapies.