title: Donor morbidity in right and left hemiliver living donor liver transplantation: the impact of graft selection and surgical innovation on donor safety.
abstract: This study investigated adequate liver graft selection for donor safety by comparing postoperative donor liver function and morbidity between the right and left hemilivers (RL and LL, respectively) of living donors. Between April 2006 and March 2012, RL (n = 168) and LL (n = 140) donor operations were performed for liver transplantation at Kyoto University Hospital. Postoperative hyperbilirubinemia and coagulopathy persisted in RL donors, whereas the liver function of LL donors normalized more rapidly. The overall complication rate of the RL donors was significantly higher than that of the LL donors (59.5% vs. 30.7%; P < 0.001). There were no significant differences in severe complications worse than Clavien grade IIIa or in biliary complication rates between the two donor groups. In April 2006, we introduced an innovative surgical procedure: hilar dissection preserving the blood supply to the bile duct during donor hepatectomy. Compared with our previous outcomes (1990-2006), the biliary complication rate of the RL donors decreased from 12.2% to 7.2%, and the severity of these complications was significantly lower. In conclusion, LL donors demonstrated good recovery in postoperative liver function and lower morbidity, and our surgical innovations reduced the severity of biliary complications in living donors.
authors.affiliation: Division of Hepatobiliary Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Iwasaki
authors.forename: Taku
authors.initials: T
authors.lastname: Iida
authors.forename: Masaki
authors.initials: M
authors.lastname: Mizumoto
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Uemura
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yagi
authors.forename: Tomohide
authors.initials: T
authors.lastname: Hori
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Akira
authors.initials: A
authors.lastname: Mori
authors.forename: Toshimi
authors.initials: T
authors.lastname: Kaido
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000328:Adult; D001652:Bile Ducts / Q000098:blood supply / Q000601:surgery; D001660:Biliary Tract Diseases / Q000209:etiology / Q000517:prevention & control; D046148:Donor Selection / Q000379:methods; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D020858:Tissue and Organ Harvesting / Q000009:adverse effects* / Q000379:methods
keywords: biliary complication; hilar dissection; liver transplantation; living donor; morbidity