title: Donor safety in living donor liver donation: An Italian multicenter survey.
abstract: Major concerns about donor morbidity and mortality still limit the use of living donor liver transplantation (LDLT) to overcome the organ shortage. The present study assessed donor safety in LDLT in Italy reporting donor postoperative outcomes in 246 living donation procedures performed by 7 transplant centers. Outcomes were evaluated over 2 time periods using the validated Clavien 5-tier grading system, and several clinical variables were analyzed to determine the risk factors for donor morbidity. Different grafts were obtained from the 246 donor procedures (220 right lobe, 10 left lobe, and 16 left lateral segments). The median follow-up after donation was 112 months. There was no donor mortality. One or more complications occurred in 82 (33.3%) donors, and 3 of them had intraoperative complications (1.2%). Regardless of graft type, the rate of major complications (grade ≥ 3) was 12.6% (31/246). The overall donor morbidity and the rate of major complications did not differ significantly over time: 26 (10.6%) donors required hospital readmission throughout the follow-up period, whereas 5 (2.0%) donors required reoperation. Prolonged operative time (>400 minutes), intraoperative hypotension (systolic < 100 mm Hg), vascular abnormalities, and intraoperative blood loss (>300 mL) were multivariate risk factors for postoperative donor complications. In conclusion, from the standpoint of living donor surgery, a meticulous and well-standardized technique that reduces operative time and prevents blood loss and intraoperative hypotension may reduce the incidence of donor complications. Transparency in reporting results after LDLT is mandatory, and we should continue to strive for zero donor mortality. Liver Transplantation 23 184-193 2017 AASLD.
authors.affiliation: Transplant Center, Division of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lauterio
authors.affiliation: Transplant Center, Division of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.|Department of Experimental Medicine, University of Pavia, Pavia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Di Sandro
authors.affiliation: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione-University of Pittsburgh Medical Center, Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gruttadauria
authors.affiliation: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione-University of Pittsburgh Medical Center, Palermo, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Spada
authors.affiliation: Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Di Benedetto
authors.affiliation: Liver Transplant Unit, Department of Medical and Biological Sciences, University Hospital, Udine, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Baccarani
authors.affiliation: Hepato-Pancreato-Biliary Surgery and Liver Transplant Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Regalia
authors.affiliation: Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Maggiore Hospital, Milan, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Melada
authors.affiliation: Transplant Center, Division of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giacomoni
authors.affiliation: Abdominal Organ Transplant Center, Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.affiliation: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione-University of Pittsburgh Medical Center, Palermo, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Cintorino
authors.affiliation: Abdominal Organ Transplant Center, Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, Bologna, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.affiliation: Department of Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Rota
authors.affiliation: Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Maggiore Hospital, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Rossi
authors.affiliation: Hepato-Pancreato-Biliary Surgery and Liver Transplant Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mazzaferro
authors.affiliation: Liver Transplant Unit, Department of Medical and Biological Sciences, University Hospital, Udine, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Risaliti
authors.affiliation: Abdominal Organ Transplant Center, Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, Bologna, Italy.
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
authors.affiliation: Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione-University of Pittsburgh Medical Center, Palermo, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Gridelli
authors.affiliation: Transplant Center, Division of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.|School of Medicine, University of Milano-Bicocca, Milan, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: De Carlis
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology; D007558:Italy / Q000453:epidemiology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods / Q000592:standards; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult