title: Liver allograft outcomes after laparoscopic-assisted and minimal access live donor hepatectomy for transplantation.
abstract: BACKGROUND
  The critical shortage of deceased organ donors has led to live-donor hepatectomy as an alternative donor option for transplantation. Although laparoscopic hepatectomy has been well described for management of liver tumors and can be performed safely, few studies have examined early recipient allograft outcomes after laparoscopic live-donor hepatectomy. We describe our initial experience with laparoscopic-assisted and minimal-access donor hepatectomy and its potential as a safe alternative with graft function comparable with open resection in live-donor liver transplantation.
  
  
  METHODS
  We performed a retrospective analysis of our past 30 successive live-donor transplants between 2005 and 2009. Fifteen allografts were procured by standard open live-donor (OLD) hepatectomy, and 15 by laparoscopic-assisted (LALD) or minimal-access (MA) live-donor hepatectomy. Left lateral segment grafts were subcategorized and analyzed further.
  
  
  RESULTS
  Mean donor age, sex, and liver anatomy were comparable between donor groups. Early graft function as measured by peak total bilirubin level, aspartate aminotransferase level, alanine aminotransferase level, and international normalized ratio on postoperative days 2, 7, 30, and 90 were similar between groups, although the international normalized ratio was slightly more increased on postoperative day 7 in LALD grafts (1.75 ± .45 vs 1.28 ± .16; P = .02). Perioperative allograft biliary (2 of 15 vs 0 of 15; P = .48) and vascular (3 of 15 vs 1 of 15; P = .6) complication rates also were comparable between OLD and LALD/MA grafts. One-year graft and patient survival for LALD/MA was 100% compared with 93% for OLD.
  
  
  CONCLUSIONS
  Our experience shows that LALD or MA live-donor hepatectomy is a safe procedure and produces early graft function comparable with standard OLD hepatectomy. Multicenter, larger-volume experience will determine the widespread application of this technique.
authors.affiliation: Department of Surgery, Georgetown University Hospital, Washington, DC 20007, USA.
authors.forename: Arun
authors.initials: A
authors.lastname: Thenappan
authors.forename: Reena C
authors.initials: RC
authors.lastname: Jha
authors.forename: Thomas
authors.initials: T
authors.lastname: Fishbein
authors.forename: Cal
authors.initials: C
authors.lastname: Matsumoto
authors.forename: J Keith
authors.initials: JK
authors.lastname: Melancon
authors.forename: Raffaele
authors.initials: R
authors.lastname: Girlanda
authors.forename: Kirti
authors.initials: K
authors.lastname: Shetty
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Laurin
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Plotkin
authors.forename: Lynt
authors.initials: L
authors.lastname: Johnson
mesh_terms: D000328:Adult; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome