Perioperative consumption of a carbohydrate-rich drink can minimize postoperative nausea, vomiting and pain in patients undergoing outpatient cholecystectomy. Consumption of carbohydrate drinks up to 2 h prior to surgery is not associated with additional complications.

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.

Background: This study intended to assess incidence, risk factors and treatment of PV complication after living donor right hepatectomy (LDRH). Methods: This study analyzed 2979 cases of LDRH from July 1997 to December 2014 at Asan Medical Center regarding on PV complication. Results: Male and female were 2055 (69.0%) and 924 (31.0%), respectively. Mean donor age was 27.5 AE 8.1 years old. Mean body mass index was 22.70 AE 2.70. Type 1, 2, 3, and other PV anomalies were 2727 (91.6%), 113 (3.8%), 132 (4.4%), and 6 (0.2%), respectively. PV stenosis (>50% narrowing of PV diameter) occurred 47 cases (1.5%). PV reconstruction (odds ratio 7.949; p=0.012), anomalous PV anatomy (OR 4.536; p< 0.001), acute angulation between main and Left PV (60-90 OR 2.214;p=0.041, < 60 OR 7.690; p< 0.001), and no fixation of falciform ligament (OR 2.213; p=0.010) were significant risk factors for PV stenosis. Among 47 PV stenosis donors, PV stent insertion was performed in 9 cases (0.3%) which occurred 1 in type 1 (0.1%), 2 in type 2 (1.8%), 6 in type 3 (4.5%), and 0 in other types (P< 0.001). All PV complication donors had no long-term sequelae. Conclusions: PV reconstruction and no fixation of falciform ligament should be avoided to prevent PV complication during LDRH. Because donors with anomalous PV anatomy or acute angulation between main and left PV have a higher tendency to occur PV complication after LDRH, those donors require meticulous surgical techniques during operation and periodic image studies after operation.