Surgery-related morbidity in living donors of right-lobe liver graft: lessons from the first 200 cases.
BACKGROUND
Living-donor liver transplantation (LDLT) using the left lateral segment or left-lobe graft has been widely accepted, but currently, right-lobe grafts are more commonly used in many LDLT programs with yet unknown risks for donors.


METHODS
We investigated our initial 200 donors of righ-lobe grafts to focus on the incidence and variety of surgery-related morbidity. Changes in liver function tests were also analyzed to clarify the relation with donor age, steatosis of the liver, and residual liver volume (RLV). Complications were surveyed for a median period of 28.7 months.


RESULTS
In all the donors, liver enzymes and bilirubin were normalized within 1 month. Enzymes on day 1 were significantly higher in donors with older age, macrovesicular steatosis, and larger RLV. Bilirubin on day 1 was significantly higher in donors with smaller RLV. Biliary enzyme was not normalized in the majority at 1 month after donation. Seventy-five complications occurred in 69 donors. Biliary complications were most common, which consisted of 26 bile leakages (13%) and 3 biliary strictures (1.5%) in 27 donors. No significant dependence of the incidence was observed either for donor age (>or=50 years), body mass index (BMI) (>or=25 kg/m2), estimated RLV (<40%), or medical history. None of the complications led either to mortality or to long-term sequelae.


CONCLUSIONS
Complications occurred in a significant proportion of right-lobe donors irrespective of donor age, BMI, estimated RLV, and medical history. Living-liver donor surgery requires more care in right-lobe transplants.
Ito
Takashi
T
Department of Transplantation and Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan. itotaka@kuhp.kyoto-u.ac.jp
Kiuchi
Tetsuya
T
Egawa
Hiroto
H
Kaihara
Satoshi
S
Oike
Fumitaka
F
Ogura
Yasuhiro
Y
Fujimoto
Yasuhiro
Y
Ogawa
Kohei
K
Tanaka
Koichi
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002648:Child; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000502:physiology; D019520:Living Donors; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D009017:Morbidity; D012189:Retrospective Studies; D016896:Treatment Outcome
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin