Postoperative Donor Liver Damage Can Predict Recipient Short-Term Survival in Living Donor Liver Transplantation

Abstract

In living donor liver transplantation, surgical damage is a risk for graft dysfunction. We hypothesized that postoperative donor laboratory data reflect both donor liver damage and graft damage. Therefore, we evaluated how donor surgical factors affected recipient graft function and prognosis. From March 2002 to December 2020, 130 consecutive recipients and donors who underwent adult-to-adult living donor liver transplantation were analyzed. Donor perioperative surgical factors were evaluated to assess risk factors for recipient 90-day mortality by univariate analysis. Donor postoperative maximum levels of aspartate aminotransferase (AST; P=.016), alanine transaminase (P=.048), and prothrombin time-international normalized ratio (P=.034) were risk factors. Receiver operating characteristic analysis identified 214 U/L as the most appropriate cutoff value of donor postoperative AST. After excluding 22 pairs of patients without donor data, the 108 pairs were divided into 2 groups based on donor maximum AST (D-mAST) level: the low D-mAST group (D-mAST < 241 U/L, n=39) and the high D-mAST group (D-mAST ≥ 241 U/L, n=69). Donor age was significantly higher in recipients in the high D-mAST group than in the low D-mAST group (P=.033). Postoperative recipient maximum AST and alanine transaminase levels and 90-day mortality were significantly higher in the high D-mAST group than in the low D-mAST group (P=.001, P=.006, and P=.009, respectively). There were no significant differences in long-term survival, although 5-year survival was slightly lower in the high D-mAST group. Surgical liver damage to grafts, as assessed by postoperative donor AST levels, affected recipient short-term survival.