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Updated: May 24, 2026
Laparoscopic Left Hemihepatectomy Combined with Caudate Lobe Resection
Published on: April 11, 2025
Complications of living donor hepatic lobectomy--a comprehensive report
M M Abecassis1, R A Fisher, K M Olthoff
1Comprehensive Transplant Center, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. mabecass@nmh.org
Insights
Living liver donation (LLD) has a 40% complication rate, mostly minor. While most donors recover, long-term issues like hernias and psychological effects require attention.
Area of Science:
- Hepatology
- Transplantation Surgery
- Surgical Outcomes Research
Background:
- Living donor liver transplantation (LLD) is crucial but limited by donor safety concerns.
- Comprehensive data on living donor complications is essential for informed decision-making.
Purpose of the Study:
- To comprehensively assess the incidence, severity, and natural history of complications following living liver donation (LLD).
- To identify predictors of complications and their resolution timelines in LLD recipients.
Main Methods:
- An observational cohort study of 760 living donors in the Adult-to-Adult Living Donor Liver Transplantation study.
- Tracking 29 specific complications, their severity (Clavien grades), and resolution over a 12-year period.
Main Results:
- 40% of donors experienced complications (557 total), predominantly Clavien grades 1 and 2.
- Hernias (7%) and psychological complications (3%) were common late-occurring issues (>1 year postdonation).
- Complication risk correlated with transfusion needs, hypotension, and pre-donation bilirubin levels.
Conclusions:
- LLD is associated with a significant complication rate, though most are minor and resolve within a year.
- Long-term complications like hernias and psychological issues have lower resolution rates.
- This data provides critical insights for potential living donors, caregivers, and transplant centers to weigh risks and benefits.
Abstract:
A wider application of living donor liver transplantation is limited by donor morbidity concerns. An observational cohort of 760 living donors accepted for surgery and enrolled in the Adult-to-Adult Living Donor Liver Transplantation cohort study provides a comprehensive assessment of incidence, severity and natural history of living liver donation (LLD) complications. Donor morbidity (assessed by 29 specific complications), predictors, time from donation to complications and time from complication onset to resolution were measured outcomes over a 12-year period. Out of the 760 donor procedures, 20 were aborted and 740 were completed. Forty percent of donors had complications (557 complications among 296 donors), mostly Clavien grades 1 and 2. Most severe counted by complication category; grade 1 (minor, n = 232); grade 2 (possibly life-threatening, n = 269); grade 3 (residual disability, n = 5) and grade 4 (leading to death, n = 3). Hernias (7%) and psychological complications (3%) occurred >1 year postdonation. Complications risk increased with transfusion requirement, intraoperative hypotension and predonation serum bilirubin, but did not decline with the increased center experience with LLD. The probability of complication resolution within 1 year was overall 95%, but only 75% for hernias and 42% for psychological complications. This report comprehensively quantifies LLD complication risk and should inform decision making by potential donors and their caregivers.
