Improving outcomes of living-donor right hepatectomy

Complication rates of living-donor right hepatectomy remain a matter of major concern. The aim of this study was to achieve near-zero morbidity for living-donor right hepatectomy in a single centre.

All living donors who underwent right hepatectomy between January 2005 and September 2011 were enrolled in this retrospective study. During this interval, modifications in surgical technique and management included upper midline laparotomy, use of wound protectors, hanging manoeuvre during parenchymal transection using Glisson's approach, no intraoperative cholangiography, no intensive care unit stay after surgery, no central venous catheterization, and reduction in systemic heparin dose before graft removal. Donor characteristics, operative outcomes and complications graded according to Clavien's classification were recorded.

A total of 300 donors were enrolled and these were divided into three groups of 100 operated on in consecutive time periods. Groups were comparable with regard to donor characteristics. The overall complication rate was 16·0 per cent, with no deaths. From group 1 to group 3, the duration of operation (P < 0·001), length of hospital stay (P < 0·001), and rate of overall (P < 0·001) and grade IIIb (P = 0·019) complications decreased significantly. In the most recent group, the morbidity rate was 3·0 per cent without any major complications, reoperation or blood transfusions. All donors recovered completely.

This study suggests that near-zero morbidity may be reached after right hepatectomy in carefully selected living donors by continuous refinement of surgical technique and management.