title: Evolution of donor morbidity in living related liver transplantation: a single-center analysis of 165 cases.
abstract: OBJECTIVE
  During the last 14 years, living donor liver transplantation (LDLT) has evolved to an indispensable surgical strategy to minimize mortality of adult and pediatric patients awaiting transplantation. The crucial prerequisite to performing this procedure is a minimal morbidity and mortality risk to the healthy living donor. Little is known about the learning curve involved with this type of surgery.
  
  
  METHODS
  From January 1991 to August 2003, a total of 165 LDLTs were performed in our center. Of these, 135 were donations of the left-lateral lobe (LL, segments II and III), 3 were of the left lobe (L, segments II-IV), 3 were full-left lobes (FL, segments I-IV), and 24 were of the full-right lobe (FR, segments V-VIII). We divided the procedures into 3 periods: period 1 included the years 1991 to 1995 (LL, n = 49; L, n = 2; FR, n = 1), period 2 covered 1996 to 2000 (LL, n = 47), and period 3 covered 2001 to August 2003 (LL, n = 39; FR, n = 23; FL, n = 3; L, n = 1). Perioperative mortality and morbidity were assessed using a standardized classification. Length of stay in intensive care unit, postoperative hospital stay, laboratory results (bilirubin, INR, and LFTs), morbidity, and the different types of grafts in the 3 different periods were compared.
  
  
  RESULTS
  One early donor death was observed in period 1 (03/07/93, case 30; total mortality, 0.61.%). Since 1991, the perioperative morbidity has continually declined (53.8% vs. 23.4% vs. 9.2%). In period 1, 28 patients had 40 complications. In period 2, 11 patients had 12 complications, and in period 3, 6 patients had 9 complications. Within the first period, 1 donor underwent relaparotomy because of bile leakage. Postoperative hospital stay was 10 days, 7 days, and 6 days, respectively. Donation of the full right lobe, in comparison with that of the left lateral lobe, resulted in a significantly diminished liver function (bilirubin and INR) during the first 5 days after donation but did not increase morbidity. One donor from period 1 experienced late death caused by amyotrophic lateral sclerosis.
  
  
  CONCLUSIONS
  In a single center, morbidity after living liver donation strongly correlates to center experience. Despite the additional risks associated with temporary reduction of liver function, this experience enabled the team to bypass part of the learning curve when starting right lobe donation. Specific training of the surgical team and coaching by an experienced center should be implemented for centers offering this procedure to avoid the learning curve.
authors.affiliation: Department of Hepatobiliary Surgery and Transplantation, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. broering@uke.uni-hamburg.de
authors.forename: Dieter C
authors.initials: DC
authors.lastname: Broering
authors.forename: Christian
authors.initials: C
authors.lastname: Wilms
authors.forename: Pamela
authors.initials: P
authors.lastname: Bok
authors.forename: Lutz
authors.initials: L
authors.lastname: Fischer
authors.forename: Lars
authors.initials: L
authors.lastname: Mueller
authors.forename: Christian
authors.initials: C
authors.lastname: Hillert
authors.forename: Christian
authors.initials: C
authors.lastname: Lenk
authors.forename: Jong-Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Martina
authors.initials: M
authors.lastname: Sterneck
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Schulz
authors.forename: Gerrit
authors.initials: G
authors.lastname: Krupski
authors.forename: Axel
authors.initials: A
authors.lastname: Nierhaus
authors.forename: Detlef
authors.initials: D
authors.lastname: Ameis
authors.forename: Martin
authors.initials: M
authors.lastname: Burdelski
authors.forename: Xavier
authors.initials: X
authors.lastname: Rogiers
mesh_terms: D000328:Adult; D001803:Blood Transfusion; D019963:Clinical Chemistry Tests; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000502:physiology; D016031:Liver Transplantation / Q000379:methods / Q000706:statistics & numerical data; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors