title: Evaluation outcomes of donors in living donor liver transplantation: a single-center analysis of 132 donors.
abstract: BACKGROUND
  Donor safety has always been a major concern, and potential risk to the donor must be balanced against recipient benefit. However, lack of a standardized and uniform evaluation of perioperative complications is a serious limitation of the evaluation of donor morbidity. This study was designed to evaluate the outcomes of donors in adult living donor liver transplantation (LDLT) using the newer Clavien classification system in a single center in China.
  
  
  METHODS
  We prospectively analyzed the outcomes of 132 consecutive living liver donors from 2005 to 2008 using the newer Clavien classification system. The preoperative, intraoperative and postoperative data of the donors were collected and analyzed. Ordinal regression was used to analyze the ordered grades of complications.
  
  
  RESULTS
  Ninety-four (71.2%) of the donors developed postoperative complications of grade I (n=45, 34.1%), grade II (n=39, 29.5%) and grade III (n=10, 7.6%). There was no death or grade IV morbidity. Hepatic functional impairment and pleural effusion were the most frequent morbidities for living donors. Fifty-three donors (40.1%) developed hepatic functional impairment of grade I (n=40, 31.1%) and grade II (n=13, 10.0%). The ICU stay (7.8+/-1.8 days) and length of hospital stay (17.7+/-4.6 days) were significantly longer in donors with grade III than others. Furthermore, ordinal logistic regression revealed that donor's older age (>40 years) and right hepatectomy were associated with morbidity. In addition, only preoperative total bilirubin (within the normal range) and postoperative nadir serum phosphorus were independently associated with hepatic functional impairment. The receiver operator characteristic curve revealed that preoperative total bilirubin >18.0 μmol/L and postoperative nadir of serum phosphorus <1 mg/dL may lead to more severe hepatic functional impairment.
  
  
  CONCLUSIONS
  Despite the fact that donors are relatively safe to undergo hepatectomy, many living donors still experience postoperative morbidity. Meticulous technical and preoperative donor evaluation and treatment are sure to reduce the incidence of complications.
authors.affiliation: Department of Liver and Vascular Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, China.
authors.forename: Ding
authors.initials: D
authors.lastname: Yuan
authors.forename: Yong-Gang
authors.initials: YG
authors.lastname: Wei
authors.forename: Bo
authors.initials: B
authors.lastname: Li
authors.forename: Lu-Nan
authors.initials: LN
authors.lastname: Yan
authors.forename: Tian-Fu
authors.initials: TF
authors.lastname: Wen
authors.forename: Ji-Chun
authors.initials: JC
authors.lastname: Zhao
authors.forename: Yong
authors.initials: Y
authors.lastname: Zeng
authors.forename: Ke-Fei
authors.initials: KF
authors.lastname: Chen
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002681:China; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult