title: Surgical outcome of right liver donors in living donor liver transplantation: single-center experience with 500 cases.
abstract: BACKGROUND
  With the increasing number of living donor liver transplantation (LDLT), concerns regarding morbidity and mortality of donors have become inevitable. Thus, the aim of the present study was to find ways to reduce the rate of morbidity and mortality of donors by analyzing our experience.
  
  
  METHODS
  A retrospective clinicopathologic analysis was performed for 500 consecutive living donors who underwent donor right hepatectomy between May 1999 and February 2011. We chronologically divided those procedures into three periods: period A (n = 100), period B (n = 200), and period C (n = 200). Surgical outcomes according to each period were then compared.
  
  
  RESULTS
  Over time, the following factors have decreased: the operative time, the amount of transfusions during surgery, hospital stay, and the incidence of biliary complications. No mortality developed. Even though the total complication rate was high (21.6 %, n = 108) including 10.6 % (n = 53) of biliary complications, the grade 3 complication rate was only 9.4 % (n = 47). In most patients with grade 3 complication, interventional therapies via radiologic or endoscopic approaches corrected these complications, and reoperation was required for ten patients (2 %). Whereas biliary complications were related with operation period (period B or C compared to period A; relative risk [RR] 2.10, P = 0.049, 95 % CI 1.01-4.39) and operative time (RR 1.01, P = 0.027, 95 % CI 1.00-1.02), postoperative hyperbilirubinemia (serum total bilirubin ≥ 5 mg/dL) was related with male gender (RR 2.68, P = 0.039, 95 % CI 1.05-6.85) and ≥ 25 % liver steatosis (RR 3.35, P = 0.053, 95 % CI 0.99-11.38).
  
  
  CONCLUSIONS
  Optimization of donor selection as well as institutional experience is imperative to improve the surgical outcome. Even though donor hepatectomy was associated with relatively higher complication rate, most complications showed low-grade severity which could be corrected by interventional therapies.
authors.affiliation: Department of Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, South Korea.
authors.forename: Say-June
authors.initials: SJ
authors.lastname: Kim
authors.forename: Gun-Hyung
authors.initials: GH
authors.lastname: Na
authors.forename: Ho-Joong
authors.initials: HJ
authors.lastname: Choi
authors.forename: Young-Kyung
authors.initials: YK
authors.lastname: Yoo
authors.forename: Dong-Goo
authors.initials: DG
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D046148:Donor Selection; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D007902:Length of Stay / Q000639:trends; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult