Surgery-related morbidity in living donors of right-lobe liver graft: Lessons from the first 200 cases

Background. Living-donor liver transplantation (LDLT) using the left lateral segment or left-lobe graft has been widely accepted, but currently, right-lobe grafts are more commonly used in many LDLT programs with yet unknown risks for donors. Methods. We. investigated our initial 200 donors of righ-lobe grafts to focus on the incidence. and variety of surgery-related morbidity. Changes in liver function tests were also analyzed to clarify the relation with donor age, steatosis of the liver, and residual liver volume (RLV). Complications were surveyed for a median period of 28.7 months. Results. In all the donors, liver enzymes and bilirubin were normalized within 1 month. Enzymes on day 1 were significantly higher in donors with older age, macrovesicular steatosis, and larger RLV. Bilirubin on day I was significantly higher in donors with smaller RLV. Biliary enzyme was not normalized in the majority at 1 month after donation. Seventy-five complications occurred in 69 donors. Biliary complications were most common, which consisted of 26 bile leakages (13%) and 3 biliary strictures (1.5%) in 27 donors. No significant dependence of the incidence was observed either for donor age (2:50 years), body mass index (BMI) (greater than or equal to25 kg/m2), estimated RLV (<40%), or medical history. None of the complications led either to mortality or to long-term sequelae. Conclusions. Complications occurred in a significant proportion of right-lobe donors irrespective of donor age, BMI, estimated RLV, and medical history. Living-liver donor surgery requires more care in right-lobe transplants.