Surgical Outcome of Right Liver Donors in Living Donor Liver Transplantation: Single-Center Experience with 500 Cases

Kim, Say-June; Na, Gun-Hyung; Choi, Ho Joong; Yoo, Young Sik; Kim, Dong-Goo

doi:10.1007/s11605-012-1865-y

Cited by 50 publications

(77 citation statements)

References 32 publications

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“…Donation should be absolutely voluntary. Detailed surgical techniques and donor selection criteria as applied in donor operations were described in previous reports by the centers involved in Korea …”

Section: Methodsmentioning

confidence: 99%

Donor safety in living donor liver transplantation: The Korean organ transplantation registry study

Lee

Kwon

et al. 2017

Liver Transpl

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Major concerns about donor safety cause controversy and limit the use of living donor liver transplantation to overcome organ shortages. The Korean Organ Transplantation Registry established a nationwide organ transplantation registration system in 2014. We reviewed the prospectively collected data of all 832 living liver donors who underwent procedures between April 2014 and December 2015. We allocated the donors to a left lobe group (n = 59) and a right lobe group (n = 773) and analyzed the relations between graft types and remaining liver volumes and complications (graded using the Clavien 5-tier grading system). The median follow-up was 19 months (range, 10-31 months). During the study period, 553 men and 279 women donated livers, and there were no deaths after living liver donation. The overall, biliary, and major complication (grade ≥ III) rates were 9.3%, 1.7%, and 1.9%, respectively. The graft types and remaining liver volume were associated with significantly different overall, biliary, and major complication rates. Of the 16 patients with major complications, 9 (56.3%) involved biliary complications (2 biliary strictures [12.5%] and 7 bile leakages [43.8%]). Among the 832 donors, the mean aspartate transaminase, alanine aminotransferase, and total bilirubin levels were 23.9 ± 8.1 IU/L, 20.9 ± 11.3 IU/L, and 0.8 ± 0.4 mg/dL, respectively, 6 months after liver donation. In conclusion, biliary complications were the most common types of major morbidity in living liver donors. Donor hepatectomy can be performed successfully with minimal and easily controlled complications. Our study shows that prospective, nationwide cohort data provide an important means of investigating the safety in living liver donation. Liver Transplantation 23 999-1006 2017 AASLD.

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Section: Methodsmentioning

confidence: 99%

Donor safety in living donor liver transplantation: The Korean organ transplantation registry study

Lee

Kwon

et al. 2017

Liver Transpl

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“…However, the scarcity of liver grafts from deceased donors remains a major issue while the number of patients waiting for a liver transplant is rising[26,27]. The problem has led to not only the employment of LDLT but also the use of suboptimal liver grafts - grafts with mild steatosis and grafts from older donors, obese donors, and donors with a borderline small potential residual liver volume[28-31]. At our center, the use of RL for LDLT has been well established with satisfactory long-term graft survival and patient survival[32].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of right-lobe and left-lobe living-donor liver transplantations using small-for-size grafts

She¹,

Chok²,

Chan³

et al. 2017

WJG

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AIMTo analyze the outcomes of living-donor liver transplantation (LDLT) using left-lobe (LL) or right-lobe (RL) small-for-size (SFS) grafts.METHODSProspectively collected data of adult patients who underwent LDLT at our hospital in the period from January 2003 to December 2013 were reviewed. The patients were divided into the RL-LDLT group and the LL-LDLT group. The two groups were compared in terms of short- and long-term outcomes, including incidence of postoperative complication, graft function, graft survival, and patient survival. A SFS graft was defined as a graft with a ratio of graft weight (GW) to recipient standard liver volume (RSLV) (GW/RSLV) of < 50%. The Urata formula was used to estimate RSLV.RESULTSTotally 218 patients were included for analysis, with 199 patients in the RL-LDLT group and 19 patients in the LL-LDLT group. The two groups were similar in terms of age (median, 53 years in the RL-LDLT group and 52 years in the LL-LDLT group, P = 0.997) but had significantly different ratios of men to women (165:34 in the RL-LDLT group and 8:11 in the LL-LDLT group, P < 0.0001). The two groups were also significantly different in GW (P < 0.0001), GW/RSLV (P < 0.0001), and graft cold ischemic time (P = 0.007). When it comes to postoperative complication, the groups were comparable (P = 0.105). Five patients died in hospital, 4 (2%) in the RL-LDLT group and 1 (5.3%) in the LL-LDLT group (P = 0.918). There were 38 graft losses, 33 (16.6%) in the RL-LDLT group and 5 (26.3%) in the LL-LDLT group (P = 0.452). The 5-year graft survival rate was significantly better in the RL-LDLT group (95.2% vs 89.5%, P = 0.049). The two groups had similar 5-year patient survival rates (RL-LDLT: 86.8%, LL-LDLT: 89.5%, P = 0.476).CONCLUSIONThe use of SFS graft in LDLT requires careful tailor-made surgical planning and meticulous operation. LL-LDLT can be a good alternative to RL-LDLT with similar recipient outcomes but a lower donor risk. Further research into different patient conditions is needed in order to validate the use of LL graft.

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“…On analysis of factors associated with biliary complications, only the use of a left lateral sectoral graft was significant (P < 0.001). Although the age of the donor (higher biliary complications in younger donors), (4) type of graft (higher in right hemiliver grafts as compared to left), (5) longer operative time, (6) intraoperative blood loss (no difference in biliary complications), (8) era effect (decreasing complications with time), (6) and center experience (no change with increasing experience) (4) have been reported to be variably associated with biliary complications in published literature, we have not found any significant association probably because of the low incidence of complications encountered.…”

Section: Discussionmentioning

confidence: 99%

Biliary complications after living donor hepatectomy: A first report from India

Pamecha¹,

Bharathy²,

Kumar³

et al. 2016

Liver Transpl

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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.

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Surgical Outcome of Right Liver Donors in Living Donor Liver Transplantation: Single-Center Experience with 500 Cases

Cited by 50 publications

References 32 publications

Donor safety in living donor liver transplantation: The Korean organ transplantation registry study

Donor safety in living donor liver transplantation: The Korean organ transplantation registry study

Outcomes of right-lobe and left-lobe living-donor liver transplantations using small-for-size grafts

Biliary complications after living donor hepatectomy: A first report from India

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