Related Experiment Video
Updated: May 6, 2026
Author Spotlight: Advancements and Challenges in Machine Perfusion for Liver Transplantation
Published on: June 14, 2024
Perpetuating proficiency in donor right hepatectomy for living donor liver transplantation
See Ching Chan1, Albert C Y Chan2, William W Sharr2
1Department of Surgery, The University of Hong Kong, Hong Kong, China; State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China.
Insights
Donor right hepatectomy (DRH) is a complex surgery for living liver donors. This study shows newer surgeons at an established center can perform DRH safely with good outcomes, minimizing donor risk.
Area of Science:
- Hepatobiliary Surgery
- Transplant Surgery
- Surgical Outcomes Research
Background:
- Donor right hepatectomy (DRH) is a critical procedure in adult living donor liver transplantation.
- Ensuring the lowest possible morbidity and mortality for living liver donors is paramount.
- Standardized DRH techniques aim to improve donor safety and surgical outcomes.
Purpose of the Study:
- To evaluate the surgical outcomes of DRH performed by less experienced surgeons.
- To assess the transferability and safety of standardized DRH techniques.
- To analyze the impact of surgeon experience on donor outcomes in a high-volume center.
Main Methods:
- Retrospective analysis of 450 consecutive donor right hepatectomies.
- Comparison of outcomes between an initial phase (Era I) and a later phase (Era II) with newer surgeons.
- Detailed assessment of blood loss, operation time, and complication rates.
Main Results:
- While blood loss and operation time increased initially with newer surgeons, complication rates did not significantly worsen.
- The learning curve effect observed in early cases was not apparent in later cases.
- No donor deaths occurred in the later phase (Era II), compared to one in the earlier phase (Era I).
Conclusions:
- Donor right hepatectomy can be safely performed by newer surgeons at an established center.
- The standardized procedure allows for successful transfer of surgical techniques.
- Good surgical outcomes and donor safety are achievable with appropriate training and guidance.
Background/Objective:
Donor right hepatectomy (DRH) was developed by master liver surgeons and has been applied in many liver transplant centers as the mainstay for adult living donor liver transplantation. It is a major and complex surgical operation performed on living liver donors for the benefit of liver recipients. The donors deserve the lowest though inevitable morbidity and mortality. In this study, the surgical outcomes of DRH performed by newer surgeons at an established center were studied to assess the transferability of the techniques of this standardized procedure.
Methods:
We studied 450 consecutive DRHs performed by 11 surgeons. Three surgeons initiated and developed the transplant program and performed the first 200 DRHs (Era I). The role of chief surgeon in the following 250 DRHs (Era II) was gradually taken up by four newer surgeons with close guidance initially.
Results:
Blood loss and operation time at the end of Era I versus the beginning of Era II were 251 vs. 341 mL and 391 vs. 497 minutes. The learning curve effect in Era I did not occur in Era II. The complication rates of the last 50 cases in Era I and Era II were 16% and 24%, respectively. Era I had one donor death whereas Era II had no donor death.
Conclusion:
At an established center, DRH can be carried out safely by newer surgeons with good outcomes.
