Analysis and Outcomes of Right Lobe Hepatectomy in 101 Consecutive Living Donors

Abstract

The shortage of deceased organ donors has created a need for right lobe living donor liver transplantation (RLDLT) in adults. Concerns regarding donor safety, however, necessitate continuous assessment of donor acceptance criteria and documentation of donor morbidity. We report the outcomes of our first 101 donors who underwent right lobectomy between April 2000 and November 2004. The cohort comprised 58 men and 43 women with a median age of 37.8 years (range: 18.6-55 years); median follow-up is 24 months. The middle hepatic vein (MHV) was taken with the graft in 55 donors. All complications were recorded prospectively and stratified by grade according to Clavien's classification. Overall morbidity rate was 37%; all complications were either grade 1 or 2, and the majority occurred during the first 30 days after surgery. Removal of the MHV did not affect morbidity rate. There were significantly fewer complications in the later half of our experience. All donors are well and have returned to full activities. With careful donor selection and specialized patient care, low morbidity rates can be achieved after right hepatectomy for living donor liver transplantation.

Intraoperative ‘No Go’ Donor Hepatectomies in Living Donor Liver Transplantation

“…At present, LDLT comprises less than 5% of adult LTx, and any further growth of LDLT will depend on defining the optimal recipient and donor characteristics for this procedure as well as broader acceptance and experience in the transplant community. (3)(4)(5). In our own cohort we also a noted a learning curve with significantly fewer complications after the first 50 donor operations (5).…”

“…(3)(4)(5). In our own cohort we also a noted a learning curve with significantly fewer complications after the first 50 donor operations (5). (3,5 …”

Reduced Mortality with Right-Lobe Living Donor Compared to Deceased-Donor Liver Transplantation When Analyzed from the Time of Listing

“…Donors had to be between 18 and 60 years of age and capable of providing informed consent. The evaluation process, institutional preferences for operative technique, and surgical procedures for the donor right hepatectomy have been described previously (2,(15)(16)(17)(18) …”

Living Anonymous Liver Donation: Case Report and Ethical Justification

“…Driven by the critical shortage of deceased donor livers, our Multi-Organ Transplant Program at the Toronto University Health Network (UHN) has developed extensive experience performing liver transplants from living donors. Since 1999, UHN has completed 187 living liver donor transplants with an estimated 37% overall rate of complications, but with no permanent complications or donor deaths (4). In adults, transplantation of the right lobe has become our accepted practice with excellent donor and recipient outcomes (4).…”