Living Donor Left Hepatectomy as a Risk Factor for Extremely Severe Bile Leakage Requiring Nonconservative Treatment:...

The safety of donors is the most important principle in living-donor liver transplant. However, some donors experience postoperative bile leakage of varying severity. In this study, we aimed to evaluate the charac-teristics of patients with severe bile leakage (Clavien-Dindo ≥grade IIIa) following donor hepatectomy.

We retrospectively reviewed 453 living donor liver transplant donors at Kumamoto University Hospital from August 2000 to March 2017.

The number of donor hepatectomies was as follows: 173 with right hepatectomy, 149 with left hepatectomy, and 131 with left lateral segmen-tectomy. The overall incidence of severe bile leakage requiring any endoscopic or surgical intervention was 4.6%. Although no differences in the incidence of bile leakage were found among the types of hepatectomy, extremely severe bile leakage caused by injury of the major remnant bile duct requiring endoscopic retrograde biliary drainage or surgical revision was observed with left hepatectomy only (n = 6).

Left hepatectomy is considered a potential risk factor for extremely severe bile leakage. Preoperative anatomical evaluation of the branching pattern and running course of the biliary tree of the right lobe and careful transection of the hepatic parenchyma near the hilar plate are important.