Benchmarking Donor Safety: Postoperative Complications and Risk Stratification in 502 Living Liver Donors

Background and Objectives: Living donor hepatectomy is an essential component of liver transplantation programs, with donor safety representing the foremost priority. This study aimed to evaluate early postoperative complications in living liver donors and to identify clinical and demographic factors associated with complication risk using the Clavien-Dindo classification. Materials and Methods: A retrospective analysis was conducted on 502 consecutive living liver donors who underwent hepatectomy between August 2021 and May 2025. Donors received standardized preoperative evaluation, surgical management, and postoperative follow-up. Demographic characteristics, graft-related variables, remnant liver ratio, and clinical outcomes were recorded. Postoperative complications were graded using the Clavien-Dindo classification, with Grade ≥ IIIa defined as major complications. Univariable and multivariable logistic regression analyses were performed. Results: Postoperative complications occurred in 58 donors (11.6%; 95% CI: 9.0-14.6%), the majority of which were mild to moderate (Grades I and II). Biliary complications were the most frequent cause of morbidity. Major complications (≥Grade IIIa) were observed in 17 donors, while no Grade IV and V complications or mortalities were recorded. Donors with complications had significantly longer hospital stays (p = 0.0002). Although crude complication rates were higher among Turkish donors than foreign donors (13.9% vs. 7.5%, p = 0.043), this association did not remain statistically significant after multivariable adjustment. No independent associations were identified between complication risk and graft type, remnant liver ratio, graft volume, or BMI. Conclusions: Living donor hepatectomy was associated with a low rate of severe early postoperative complications under standardized protocols. However, given the retrospective design and limited structured long-term follow-up, these findings primarily reflect early postoperative safety. Biliary complications remain the most common postoperative issue. Further multicenter prospective studies with extended follow-up are needed to comprehensively assess long-term donor outcomes.