Living donor liver transplantation: donor selection, evaluation, and surgical complications:

The results of vascular and biliary variations in turks liver donors: comparison with others

Objective. To evaluate liver anatomy with a view to access unerring surgery in liver donors. Summary Background Data. Liver transplantation, the unique curative treatment option for end-stage hepatic failure, has become routinely practicable, which was inconceivable in the past. But, the vascular and biliary anatomy of the liver has not been completely disclosed yet. Methods. From 1994 to 2009, we have done a research on 496 liver donors. The data were accumulated and categorized according to the most widely used classification systems. Results. Of 496 liver donors, 393 (79.1%) underwent the right donor hepatectomy, 98 (19.9%) were performed the left lateral segmentectomy, and 5 donors (1%) underwent the left donor hepatectomy surgery. Given the data regarding to 398 liver donors undergone right and left donor hepatectomy, arteries, bile ducts, and portal vein showed classical anatomy in 107 (21.6%) donors. Variations in all three systems were found in 16 donors (3.2%). In the remaining 275 donors (75.2%), anatomical variations were found at either of arterial, biliary, or portal system. Conclusions. Our study could come up to actual estimate in liver anatomy as any of donors have not been removed in our institute due to high hilar dissection technique.

Outcome of donors with a remnant liver volume of less than 35% after right hepatectomy

To overcome the barrier of size match, right lobe graft has been widely used in living donor liver transplantation (LDLT). We assessed donor outcome, with a focus on remnant liver volume (RLV) after right hepatectomy based on the experiences of 2 LDLT centers, as a means of guiding the establishment of safe RLV limits for donor right hepatectomy. Between January 2002 and December 2003, a consecutive 146 liver donors who underwent right hepatectomy with at least 12 months of follow-up were enrolled in this study. Donors were grouped into 2 groups according to RLV: group 1 (n = 74), <35% (range, 26.9-34.9) and group 2 (n = 72), > or = 35% (35.0-46.8). No donors died or suffered a life-threatening complication. Mean peak serum postoperative aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (IU/L) levels were 219.5 +/- 79.9 and 231.5 +/- 83.3 in group 1 and 210.3 +/- 81.6 and 225.8 +/- 93.0 in group 2 (P = 0.497 and 0.699), respectively. Mean peak serum total bilirubin (TB) (mg/dL) level in group 1 (3.4 +/- 1.6) was higher than in group 2 (2.8 +/- 1.4; P = 0.023). Overall 23 (15.8%) major morbidities, 10 in group 1 (13.5%) and 13 in group 2 (18.1%), occurred according to Clavien's system (P = 0.939). These included bleeding (n = 3 in group 1 and n = 6 in group 2; P = 0.282), ileus (n = 3 and 1; P = 0.324), biliary leakage (n = 4 and 4; P = 0.968), and pneumonia (n = 0 and 2; P = 0.149). Minor morbidities were also comparable in the 2 groups. In conclusion, the outcome of donors with an RLV of <35% was not different from that of donors with an RLV of > or = 35%, with the exception of transient cholestasis. Therefore, a remnant RLV of <35% does not appear to be a contraindication for right liver procurement in living donors.