title: Outcome of donors with a remnant liver volume of less than 35% after right hepatectomy.
abstract: To overcome the barrier of size match, right lobe graft has been widely used in living donor liver transplantation (LDLT). We assessed donor outcome, with a focus on remnant liver volume (RLV) after right hepatectomy based on the experiences of 2 LDLT centers, as a means of guiding the establishment of safe RLV limits for donor right hepatectomy. Between January 2002 and December 2003, a consecutive 146 liver donors who underwent right hepatectomy with at least 12 months of follow-up were enrolled in this study. Donors were grouped into 2 groups according to RLV: group 1 (n = 74), <35% (range, 26.9-34.9) and group 2 (n = 72), > or = 35% (35.0-46.8). No donors died or suffered a life-threatening complication. Mean peak serum postoperative aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (IU/L) levels were 219.5 +/- 79.9 and 231.5 +/- 83.3 in group 1 and 210.3 +/- 81.6 and 225.8 +/- 93.0 in group 2 (P = 0.497 and 0.699), respectively. Mean peak serum total bilirubin (TB) (mg/dL) level in group 1 (3.4 +/- 1.6) was higher than in group 2 (2.8 +/- 1.4; P = 0.023). Overall 23 (15.8%) major morbidities, 10 in group 1 (13.5%) and 13 in group 2 (18.1%), occurred according to Clavien's system (P = 0.939). These included bleeding (n = 3 in group 1 and n = 6 in group 2; P = 0.282), ileus (n = 3 and 1; P = 0.324), biliary leakage (n = 4 and 4; P = 0.968), and pneumonia (n = 0 and 2; P = 0.149). Minor morbidities were also comparable in the 2 groups. In conclusion, the outcome of donors with an RLV of <35% was not different from that of donors with an RLV of > or = 35%, with the exception of transient cholestasis. Therefore, a remnant RLV of <35% does not appear to be a contraindication for right liver procurement in living donors.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Chongno-gu, Seoul, Korea.
authors.forename: Jai Young
authors.initials: JY
authors.lastname: Cho
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
authors.forename: Choon Hyuck
authors.initials: CH
authors.lastname: Kwon
authors.forename: Nam-Joon
authors.initials: NJ
authors.lastname: Yi
authors.forename: Hwan Hyo
authors.initials: HH
authors.lastname: Lee
authors.forename: Jean Wan
authors.initials: JW
authors.lastname: Park
authors.forename: Kwang-Woong
authors.initials: KW
authors.lastname: Lee
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Joh
authors.forename: Suk-Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Kuhn Uk
authors.initials: KU
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D008111:Liver Function Tests; D008115:Liver Regeneration / Q000502:physiology*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods; D009929:Organ Size; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011336:Probability; D018570:Risk Assessment; D017678:Sex Distribution