A stringent stepwise donor evaluation process leads to early recognition of unsuitable donors and a low complication rate.

Biliary complications after donor hepatectomy can result in significant morbidity. We herein present our experience of donor hepatectomy, highlighting surgical techniques that prevent complications. Data were reviewed from a prospectively maintained database of all donors who underwent hepatectomy from April 2011 to April 2015. Standard operative technique as described was followed in all patients. Biliary complications and morbidity were recorded and stratified as per Clavien-Dindo classification. Results were compared with published literature. During the study period, 160 donors underwent hepatectomy. The majority of the graft types were right hemiliver without the middle hepatic vein (71.9%). Major complications (grade III and above) occurred in 5.6% of the donors. There was no donor mortality. Only 1 out of the 160 donors (0.6%) has had a grade III biliary complication requiring endoscopic retrograde cholangiography and papillotomy. There were 3 grade II biliary complications, all occurring after left lateral sectionectomy, necessitating prolonged retention of the intra-abdominal drain. The median duration of hospital stay was 11 days (range, 5-67 days), and the duration of follow-up was 16 months (range, 3-52 months). There was no loss to follow-up, and no donor required readmission or outpatient procedures for any biliary complication. In conclusion, with careful donor selection and a standardized surgical technique, biliary complications can be minimized.

In countries where deceased organ donation is sparse, emergency living donor liver transplantation (LDLT) is the only lifesaving option in select patients with acute liver failure (ALF). The aim of the current study is living liver donor safety and recipient outcomes following LDLT for ALF. A total of 410 patients underwent LDLT between March 2011 and February 2018, out of which 61 (14.9%) were for ALF. All satisfied the King’s College criteria (KCC). Median admission to transplant time was 48 hours (range, 24‐80.5 hours), and median living donor evaluation time was 18 hours (14‐20 hours). Median Model for End‐Stage Liver Disease score was 37 (32‐40) with more than two‐thirds having grade 3 or 4 encephalopathy and 70% being on mechanical ventilation. The most common etiology was viral (37%). Median jaundice‐to‐encephalopathy time was 15 (9‐29) days. Preoperative culture was positive in 47.5%. There was no difference in the complication rate among emergency and elective living liver donors (13.1% versus 21.2%; P = 0.19). There was no donor mortality. For patients who met the KCC but did not undergo LT, survival was 22.8% (29/127). The 5‐year post‐LT actuarial survival was 65.57% with a median follow‐up of 35 months. On multivariate analysis, postoperative worsening of cerebral edema (CE; hazard ratio [HR], 2.53; 95% confidence interval [CI], 1.01‐6.31), systemic inflammatory response syndrome (SIRS; HR, 16.7; 95% CI, 2.05‐136.7), preoperative culture positivity (HR, 6.54; 95% CI, 2.24‐19.07), and a longer anhepatic phase duration (HR, 1.01; 95% CI, 1.00‐1.02) predicted poor outcomes. In conclusion, emergency LDLT is lifesaving in selected patients with ALF. Outcomes of emergency living liver donation were comparable to that of elective donors. Postoperative worsening of CE, preoperative SIRS, and sepsis predicted outcome after LDLT for ALF.

Cytokines and growth factors have prominent roles in liver regeneration. The aim of this study was to evaluate the biological markers of liver regeneration in healthy donors undergoing right lobe donor hepatectomy for living donor liver transplantation. Twenty-five voluntary liver donors were enrolled. Peripheral blood samples were taken a day before the operation and on postoperative days (PODs) 1, 3, 7, 14, and 42. Levels of hepatocyte growth factor (HGF), interleukin (IL) 6, tumor necrosis factor a (TNF-a), thrombopoietin (TPO), transforming growth factor b1 (TGF-b1), interferon (IFN) a, and IFNg were monitored. The remnant liver volume (RLV) before surgery and regeneration liver volume (RgV) on POD 14 were calculated on computed tomography (CT). RgV/RLV ratio was correlated with the remnant-liver-volume-to-body-weight ratio (RLVBWR). Inverse correlation was observed between RgV/RLV and RLVBWR (r 2 5 0.61; P < 0.001). There was a significant rise of HGF on POD 1 (P 5 0.001), POD 7 (P 5 0.049), and POD 14 (P 5 0.04). TNF-a was elevated on POD 1 (P 5 0.004). The levels of IL 6 (P < 0.001) and TPO (P < 0.001) were higher from POD 1 to POD 42. IFNa was higher on POD 14 (P 5 0.003) and POD 42 (P 5 0.001). There was a significant fall of IFNg on POD 1 (P 5 0.01) and increase on POD 14 (P 5 0.04). The levels of TGF-b1 were higher on POD 14 (P 5 0.008) and on POD 42 (P 5 0.002). In conclusion, HGF, IL 6, TNF-a, and TPO are involved in the early phase, whereas TGF-b1 and IFN are involved in the termination phase of liver regeneration. Liver regeneration was observed to be higher in donors with low RLVBWR. Liver Transpl 22:344-351, 2016. V C 2015 AASLD.

This study aimed to evaluate the association of postoperative thrombocytopenia with outcome following adult living donor liver transplantation (LDLT) for end-stage liver disease (ESLD). It was a prospective study of 120 consecutive adult LDLT from September 2012 to May 2015. Preoperative platelet counts (PLTs) and postoperative PLTs were recorded at regular intervals till 3 months after LDLT. Univariate and multivariate analyses were performed. The median pretransplant PLT was 61 × 10(9) /l. The lowest median PLT after LDLT was observed on POD 3. Patients were stratified into low platelet group (n = 83) with PLT <30 × 10(9) /l and high platelet group (n = 37) with PLT ≥30 × 10(9) /l. Patients with PLT <30 × 10(9) /l had statistically significant higher grade III/IV complication (P = 0.001), early graft dysfunction (P = 0.01), sepsis (P = 0.001), and prolonged ascites drainage (P = 0.002). On multivariate analysis, PLT<30 × 10(9) /l was identified as an independent risk factor for grade III/IV complications (P = 0.005). Overall, patients survival was significantly different between two groups (P = 0.04), but this predictive value was lost in patients who survived more than 90 days (P = 0.37). Postoperative PLT of <30 × 10(9) /l was a strong predictor of major postoperative complications and is associated with early graft dysfunction, prolonged ascites drainage, and sepsis. The perioperative mortality rate was high in the thrombocytopenia group.