Living donor liver transplantation is now a common practice in countries in which the availability of cadaveric organs is limited. The preoperative preparation, intraoperative surgical technique, and postoperative care of donors and recipients have evolved in recent years. We retrospectively compared 67 donors with a remnant liver volume equal to or more than 30% (group 1) with 14 donors who had less than 30% remnant liver volume (group 2) for donor outcomes. All the complications in donors were systematically classified. Donors with less than 30% remnant liver volume showed significantly higher peak aspartate aminotransferase, alanine aminotransferase, international normalized ratio, and bilirubin levels. There were 6 complications in group 1 and 4 complications in group 2. The difference between the 2 groups in terms of donor complications did reach statistical significance (P ϭ 0.043); donors with a remnant liver volume Ͻ 30% had a 4 times greater relative risk of morbidity.In conclusion, the use of donors with less than 30% remnant liver volume is highly debatable as donor safety should be of utmost importance in living donor liver transplantation. Living donor liver transplantation (LDLT) is now an accepted treatment modality for end-stage liver disease. It has become an alternative in the era of organ shortage. This procedure is possible because of the segmental structure of the liver and the regeneration potential of the transplanted and remnant parts. After years of extensive experience in adult-to-child left-lobe liver transplantation, right donor hepatectomy has become a common practice in centers performing adult-to-adult LDLT. Despite impressive results, right-lobe LDLT involves one of the most complicated and technically demanding surgical procedures and has created considerable controversy with respect to donor safety. To date, there have been 17 donor deaths reported, and the morbidity is reported to be in the range of 20% to 30%.

Although it is clear that Doppler US evaluation is an effective choice for diagnosing vascular complications after liver transplantation, we also observed that Doppler US examination plays an important role in detecting vascular complications intraoperatively and improving the patient's chance for a successful outcome.

Summary The harvesting of the middle hepatic vein (MHV) with the right lobe graft for living‐donor liver transplantation allows an optimal venous drainage for the recipient; however, it is an extensive operation for the donor. This is a prospective, nonrandomized study evaluating liver functions and early clinical outcome in donors undergoing right hepatectomy with or without MHV harvesting. From August 2005 to July 2007, a total of 100 donor right hepatectomies were performed with (n = 49) or without (n = 51) the inclusion of the MHV. The decision to take MHV was based on an algorithm that considers various donor and recipient factors. There was no donor mortality in donors in either group. Overall complication rate was higher in MHV (+) donor group, however when remnant liver volume was kept above 30%, complication rates were similar between the groups. The results of this study show that right hepatectomy including the MHV neither affects morbidity nor impairs early liver function in donors when remnant volume is kept above 30%. The decision, therefore, of the extent of right lobe donor hepatectomy should be tailored to the particular conditions considering the graft quality and metabolic demand of the recipient.

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Testicular blood flow is influenced during laparoscopic inguinal hernia surgery. Whether changes in flow parameters remain in the late postoperative period, and whether they have an impact on complications will be evaluated in further studies.

In living donor liver transplantation (LDLT), obtaining the precise volume of the graft is very important to decrease volumerelated postoperative complications, especially in cases with suspected small-for size grafts. We used stereology based on the Cavalieri method (CM), a new method to measure liver graft volume, and compared the results with those obtained through intraoperative measurement (IOM) and through multidetector computed tomography (MDCT) measurement. Liver volumes estimated using the 3 methods were well-correlated with each other (r 2 ϭ 0.94 and P Ͻ 0.001 for IOM and CM; r 2 ϭ 0.91 and P Ͻ 0.001 for IOM and MDCT, and r 2 ϭ 0.95 and P Ͻ 0.001 for CM and MDCT); however, they were different from each other (in descending order, 908 Ϯ 124 cm 3 , 861 Ϯ 121 cm 3 , and 777 Ϯ 168 cm 3 for MDCT, CM, and IOM, respectively). Although MDCT and CM overestimated the volumes, the results of CM were almost similar to those obtained via IOM. In conclusion, our results suggest that CM measured the liver graft volume more reliably. Thus, its use, particularly in cases with suspected small-for-size graft, may prove useful. Liver Transpl 13: [693][694][695][696][697][698] 2007 The shortage of cadaveric livers for transplantation continues to limit this therapy, but the use of living donors and split grafts has helped to solve this problem.1 In living donor liver transplantation (LDLT), an exact preoperative volume calculation of both the graft to be transplanted and the remaining part of the potential donor liver is crucial to avoid severe postoperative complications associated with the graft volume and the recipient recovery rate, and to maintain donor safety. 1-3The use of small-for-size grafts (graft-to-recipient weight ratio Ͻ1%) has been found to lead to lower graft survival. This lower survival rate is caused by enhanced parenchymal cell injury and reduced metabolic and synthetic capacity. Currently, LDLT is planned by multiple imaging approaches using planar reformations of ultrasonography, computed tomography (CT), magnetic resonance, and angiographic examinations. 4,5 Recently, preoperative liver volumetry-based on contrast-enhanced multidetector CT (MDCT) has resulted in significantly improved outcomes, compared to the use of 2-dimensional CT.6-11 The MDCT images revealed the anatomy of the hepatic vein, hepatic artery, and portal vein, but unfortunately volumetry by MDCT still produces an error ratio of approximately 13%.2 The error might be due to factors such as the mismatch between the cutting line in the simulation and that in the actual hepatectomy and possible changes in graft volume secondary to the lack of blood pressure on the vascular bed of the graft. On the other hand, the Cavalieri principle (CM) of stereological methodology is well suited to rapid and Abbreviations: LDLT, living donor liver transplantation; CM, Cavalieri method; IOM, intraoperative measurement; MDCT, multidetector computed tomography; CT, computed tomography; MHV, middle hepatic vein. Address reprint requests to Bulent Aydinli...

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