"Inherent limitations" in donors: control matched study of consequences following a right hepatectomy for living donation and benign liver lesions.
OBJECTIVE
The aim of this study was to identify "inherent limitations" in healthy donors who are responsible for donor morbidity after right hepatectomy (RH) for adult-to-adult living donor liver transplantation (ALDLT).


BACKGROUND
Right hepatectomy for ALDLT remains a challenging procedure without significant improvement in morbidity over time. This suggests some "inherent limitations" in healthy individuals, which are beyond the recent improvements in the donor evaluation and selection process and refinements in surgical technique during the learning curve.


METHODS
To identify response of RH in ALDLT, we prospectively studied 32 patients requiring an RH for benign liver lesions (BL), matched with 32 living donors (LD) operated by same team. All patients underwent liver volume evaluation by computed tomographic (CT) volumetry preoperatively and 1 week after RH, postoperative complications graded with Clavien's system.


RESULTS
The comparison (LD vs BL) showed that remnant liver volume (RLV) on preoperative CT volumetry was higher in the BL group (450 ± 150 vs 646 ± 200 mL, P < 0.001) representing 31% ± 7% in LD group versus 36% ± 7% of the total liver volume in BL group (P = 0.03). On postoperative day 7, the RLV was similar in the 2 groups (866 ± 162 vs 941 ± 153 mL) resulting from a significantly higher regeneration rate in the LD group (89% vs 55%, P = 0.009). Overall complications rate was lower in the BL group (46% vs 21%, P = 0.035).


CONCLUSIONS
Right hepatectomy in LDLT induces a more severe deprivation of liver volume than in BL, which induce an accelerated regeneration. Accelerated regeneration could represent "inherent limitation" in healthy donors that makes them more vulnerable for postoperative complications.
Department of HPB Surgery & Liver Transplantation, Beaujon Hospital-Assistance Publique Hôpitaux de Paris-100 Bd du Général Leclerc, 92110 Clichy, France. jacques.belghiti@bjn.aphp.fr
Jacques
J
Belghiti
Guido
G
Liddo
Vikram
V
Raut
Magaly
M
Zappa
Safi
S
Dokmak
Valérie
V
Vilgrain
François
F
Durand
Fédérica
F
Dondéro
D000293:Adolescent; D000328:Adult; D000075202:Contraindications; D046148:Donor Selection / Q000592:standards*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D055815:Young Adult