Safety of Living Liver Donors in Donor Hepatectomies
Safety of Living Liver Donors in Donor Hepatectomies
Donor safety is of paramount importance in performing living donor liver transplantation (LDLT). We retrospectively reviewed donor medical records to confirm whether larger donor hepatectomy is absolutely complication-prone. A total of 441 living donor hepatectomies were performed between October 1996 and July 2012 in our institute, which were divided into three eras (Era I, October 1996 to March 2004; Era II, April 2004 to March 2008; Era III, April 2008 to July 2012) and the incidences of postoperative complications were compared among the three types of hepatectomy—right hepatectomy (RH), left hepatectomy (LH) and left lateral segmentectomy (LLS). Although severe complications (Clavien's grade 3 or more) frequently occurred in RH in Eras I and II (15.4% and 10.7%, respectively), the incidence in Era III decreased to the comparable level observed in LH and LLS (5.4% in RH, 2.3% in LH and 5.3% in LLS). The incidence of postoperative complications did not relate to the type of hepatectomy selected in the latest era. Since most complications after hepatectomy were considered preventable, step-by-step meticulous surgical procedures are a prerequisite for further assuring donor safety irrespective of the type of hepatectomy selected.
Since the initial cases of living donor liver transplantation (LDLT) were performed, more than 20 years have already passed and LDLT has become one of the standard therapeutic modalities for patients with end stage liver disease as well as hepatocellular carcinoma. The safety of living liver donors is of paramount importance and this issue has been aggressively discussed so far. Although the liver has a capacity to regenerate, it is generally believed that the larger the resected liver parenchyma is, the more frequently postoperative complications will occur. We implemented the LDLT program in 1996 and have performed more than 400 LDLTs so far. In our experience, as observed in other transplantation centers, the incidence of postoperative complications after right hepatic donation was higher than that of left-sided hepatic donation. That is, a larger hepatectomy was considered complication-prone. Moreover, the recipient survival after left hepatic grafting was comparable to that after right hepatic grafting. We had strongly advocated the use of left-sided hepatic grafts for the sake of donor safety. Perioperative managements and operative procedures of living liver donors seemed to be established with cumulative experience. In this paper, we revisited the safety of living liver donors from the experience of more than 400 LDLTs focusing on postoperative complications after donor hepatectomy.
Abstract and Introduction
Abstract
Donor safety is of paramount importance in performing living donor liver transplantation (LDLT). We retrospectively reviewed donor medical records to confirm whether larger donor hepatectomy is absolutely complication-prone. A total of 441 living donor hepatectomies were performed between October 1996 and July 2012 in our institute, which were divided into three eras (Era I, October 1996 to March 2004; Era II, April 2004 to March 2008; Era III, April 2008 to July 2012) and the incidences of postoperative complications were compared among the three types of hepatectomy—right hepatectomy (RH), left hepatectomy (LH) and left lateral segmentectomy (LLS). Although severe complications (Clavien's grade 3 or more) frequently occurred in RH in Eras I and II (15.4% and 10.7%, respectively), the incidence in Era III decreased to the comparable level observed in LH and LLS (5.4% in RH, 2.3% in LH and 5.3% in LLS). The incidence of postoperative complications did not relate to the type of hepatectomy selected in the latest era. Since most complications after hepatectomy were considered preventable, step-by-step meticulous surgical procedures are a prerequisite for further assuring donor safety irrespective of the type of hepatectomy selected.
Introduction
Since the initial cases of living donor liver transplantation (LDLT) were performed, more than 20 years have already passed and LDLT has become one of the standard therapeutic modalities for patients with end stage liver disease as well as hepatocellular carcinoma. The safety of living liver donors is of paramount importance and this issue has been aggressively discussed so far. Although the liver has a capacity to regenerate, it is generally believed that the larger the resected liver parenchyma is, the more frequently postoperative complications will occur. We implemented the LDLT program in 1996 and have performed more than 400 LDLTs so far. In our experience, as observed in other transplantation centers, the incidence of postoperative complications after right hepatic donation was higher than that of left-sided hepatic donation. That is, a larger hepatectomy was considered complication-prone. Moreover, the recipient survival after left hepatic grafting was comparable to that after right hepatic grafting. We had strongly advocated the use of left-sided hepatic grafts for the sake of donor safety. Perioperative managements and operative procedures of living liver donors seemed to be established with cumulative experience. In this paper, we revisited the safety of living liver donors from the experience of more than 400 LDLTs focusing on postoperative complications after donor hepatectomy.
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