Background:The mini-invasive (MIS) approach to living donor hepatectomy is a current trend in experienced centers. At the same time, there are only a few reports describing the utility of laparoscopic donor hepatectomy (LDH) in settings of pediatric living donor liver transplantation (LDLT). We aimed to provide our own experience as a path to implementing the approach to routine practice. Methods: LDH was used in 276 cases of pediatric LDLT between May 2016 and August 2022. Laparoscopic left lateral sectionectomy (LapLLS) was performed in 240 cases, including 3 cases of simultaneous LapLLS and nephrectomy in the same donor. Laparoscopic living donor left hepatectomy (LapLDLH) was applied in 25 cases, including 2 cases of simultaneous LapLDLH and nephrectomy in the same donor. Laparoscopic right hepatectomy in a living donor (LapLDRH) was performed in 11 cases for LDLT in adolescent recipients. Results: In the LapLLS group, the blood loss was 50 mL (20-400 mL), the median operation time was 203 minutes (120-475 minutes) and the median length of the hospital stay was 5 days (2-19 days). The LapLDLH and LapLDRH groups were characterized by higher median blood loss 320 mL (100-700 mL) and 240 mL (100-400 mL) respectively; and also a longer operative time of 322 minutes (210-415 minutes), 380 minutes (280-470 minutes). The complication rate was similar to open procedure in both donors and recipients. Conclusions: The left-sided graft procurement (LLS and LL) is a more demanded procedure in settings of pediatric LDLT. The laparoscopic approach for living donors demonstrates all the advantages of MIS, with preserving recipient outcomes.

Deceased brain-dead donor liver transplantation (LT) is a high-risk intervention. The outcome depends on a large number of modifiable and non-modifiable factors. Objective: to analyze our own experience and identify preoperative and perioperative prognostic factors for poor outcomes in LT. Materials and methods. The study included 301 liver transplants performed between January 2016 and December 2021. Donor and recipient characteristics, intraoperative data, perioperative characteristics including laboratory test data, and the nature and frequency of complications were used for the analysis. Results. The 1-, 3- and 5-year recipient survival rates were 91.8%, 85.1%, and 77.9%, respectively; graft survival rates were 90.4%, 83.7%, and 76.7%, respectively. The most significant predictors of poor outcome of LT on the recipient side were biliary stents (HR 7.203, p < 0.01), acutely decompensated cirrhosis (HR 2.52, p = 0.02); in the postoperative period, non-surgical infectious complications (HR 4.592, p < 0.01) and number of reoperations (HR 4.063, p < 0.01). Donor creatinine level (HR 1.004, p = 0.01, one factor analysis; HR 1.004, p = 0.016, multivariate analysis) was the only reliable prognostic negative factor. Conclusion. LT taking into account established risk factors will improve surgery outcomes and help personalize the therapy for each patient.