Surgical Complications after Right Hepatectomy for Live Liver Donation: Largest Single-Center Western World Experience

Abstract

The authors assessed the incidence, management, and risk factors for postoperative complications after right lobe (RL) live donor hepatectomy in a high-volume center in North America. All donors undergoing an RL live donor hepatectomy between 2000 and 2017 at our institution were included. The primary outcome was the development of complications (both medical and surgical). Predictors of postoperative complications were determined by logistic regression. A total of 587 patients underwent RL live donor hepatectomy. Among those, 187 postoperative complications were diagnosed in 141 (24%) patients. One patient had >90-day morbidity, and there were no donor deaths. Overall complications were significantly higher in the first era, 2000 to 2008 (81 [57.4%]) versus the second era, 2009 to 2017 (60 [42.6%]) ( = 0.01). On multivariate analysis, the only predictor of postoperative complications was the center volume of RL live donor hepatectomy in the previous 12 months with an odds ratio of 0.97 (95% confidence interval: 0.95-0.99). In conclusion, increasing center volume is associated with lower rates of postoperative complications after RL living liver donation.

Complications and outcomes of 890 living liver donor hepatectomies at a single center: risks of saving loved one’s life

“…The complication rate after LLDH varies widely in the literature, between 9 and 40% (8,9,12,(14)(15)(16)(17)(18)(19)21,22). Among our donors, 19.5% experienced complications, comparable with the literature.…”

“…A data review of more than 300 articles, including nearly 6000 LLDH, has reported an overall mortality rate of 0.2% (10,13). Many single-center experiences with the same complication rate have been reported from Turkey and other countries (8,9,(14)(15)(16)(17)(18)(19).We reported briefly our complications in the first 419 LLDH cases in a previous manuscript (20). Including these reported cases, in our first 939 living liver donors, no death occurred related to surgery or complications in our program.…”

“…The incidence of morbidity and mortality after LLDH is not well known because reporting is not standardized and relies on single center, or in some countries, registry reports. Mortality rate has been reported to be 0.1% to 0.3% (9)(10)(11). Results of a worldwide survey conducted among 148 programs performing LDLT, with 71 (48%) programs in 21 countries completing the survey, including 11,553 LLDH, has been published by Cheah YL, et al (12).…”

“…In addition, minimally invasive approaches are important for functional and cosmetic demands of the donors. Minimizing the incision is an alternative, which has been reported in the literature with same outcomes (9,31). Beginning with donor left lateral sector hepatectomy in 2002 by Cherqui et al (32), laparoscopic and other minimally invasive approaches are being used today.…”

Recent advances in liver transplantation for cancer: The future of transplant oncology

“…80 After live donation, the rate of overall postoperative complications is reported to be around 25-30%, with major complications occurring in 9-10% of patients. 80,81 Donor mortality has also been reported and estimated between 0.1-0.3%. 82,83 LT for HCC: future prospects The future direction of LT for HCC will focus on the identification of patients at higher risk of recurrence to prevent futile transplantation.…”