Effect of graft type on postoperative liver function recovery in living liver donors

Donor safety is the primary focus in living-donor liver transplantation. Although, the procedure carries a significant risk of morbidity and even death, the use of marginal living donors is a current issue of discussion.

Between September 2001 and October 2008, we performed 203 liver transplantation procedures using organs from living donors. Of 203 donors, 115 were men and 88 were women, with a mean (SD; range) age of 34.5 (9; 19-66) years. One hundred fifty donors were first-degree relatives of the recipients, 36 were second-degree relatives, and 17 were spouses. We did not accept grafts with remnant volume less than 40% or from donors with impaired liver function. We performed 96 right-lobe 38 left-lobe, and 69 left-lateral segmentectomies. For the right-lobe grafts, the median hepatic vein was always left in the remnant liver. The mean ratios of remnant to total donor liver volume were 42.0%, 66.8%, and 74.6% for the right-, left-, and left lateral segmentectomies, respectively. Mean hospitalization time was 7.0, 6.2, and 9.7 days, respectively. Mean operative time was 330, 324, and 324 minutes, respectively. Only 15 donors (7.8%) received autologous blood transfusions during surgery. Liver function tests including alanine aminotransferase, aspartate aminotransferase and bilirubin concentrations and prothrombin time were assessed postoperative days 1, 3, and 5 at outpatient follow-up, usually at week 3.

There were no deaths; however, 26 complications occurred in 20 of 203 donors (5.2%), most of which were treated with radiologic interventions.

Larger grafts produce impaired function in the early postoperative period; however, they do not have a negative effect in the long term. The remnant volume should be measured fastidiously, and surgeons must avoid taking large volumes of liver, especially in right-lobe donors.