title: Living liver donation: preoperative assessment, anatomic considerations, and long-term outcome.
abstract: BACKGROUND
  A major prerequisite for living donor liver transplantation (LDLT) as an acceptable treatment modality is thoughtful consideration of the donor. However, there has been no comprehensive audit of living liver donation focusing on issues such as donor selection, anatomic surveys, and long-term outcome.
  
  
  METHODS
  Between June 1990 and January 2002 at our institution, 160 LDLTs were performed and 177 patients were referred for LDLT. For these patients, a total of 203 potential donors were screened. The process of donor selection, safety of donor hepatectomy, and postoperative morbidity were investigated. Additionally, an anonymous questionnaire was administered to 100 donors who had undergone LDLT more than 3 years previously.
  
  
  RESULTS
  Thirty-eight (19%) of the 203 donor candidates were excluded. Precise estimation of the hepatic anatomy was indispensable for donor safety. None of the donors showed prolonged postoperative liver dysfunction nor developed complications requiring reoperation or readmission. There was no donor mortality. The responses to the questionnaire indicated that 95% of the living donors had not felt coerced to donate and that 5% were neutral about coercion pressure. There were no severe postoperative aftereffects, but minor problems were reported by 51% of the respondents.
  
  
  CONCLUSIONS
  Our appraisal of the perioperative and long-term postoperative course of LDLT donors revealed that although most donors are satisfied after undergoing LDLT, there is a need for strict attention to the process of donor selection and long-term postoperative follow-up. The outcome of the present series seems to confirm the safety of donor hepatectomy.
authors.affiliation: Division of Liver Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Hisanao
authors.initials: H
authors.lastname: Chisuwa
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hashikura
authors.forename: Atsuyoshi
authors.initials: A
authors.lastname: Mita
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Miyagawa
authors.forename: Masaru
authors.initials: M
authors.lastname: Terada
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Ikegami
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Nakazawa
authors.forename: Koichi
authors.initials: K
authors.lastname: Urata
authors.forename: Shiro
authors.initials: S
authors.lastname: Ogino
authors.forename: Seiji
authors.initials: S
authors.lastname: Kawasaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003068:Coercion; D005190:Family; D014644:Genetic Variation; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D007223:Infant; D008099:Liver / Q000033:anatomy & histology; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects; D019520:Living Donors / Q000523:psychology; D008137:Longitudinal Studies; D008875:Middle Aged; D017060:Patient Satisfaction; D010560:Personnel Selection; D011184:Postoperative Period; D020127:Recovery of Function; D012449:Safety; D013997:Time Factors; D016896:Treatment Outcome