Living Donor Liver Transplantation Donors Research Articles

Is preoperative weight reduction of living-donor liver transplant recipients and donors harmful to postoperative outcomes?

AimAlthough the incidence of overweight and obese recipients and donors is increasing worldwide, few reports have focused on outcomes of preoperative weight reduction (WR) in living-donor liver transplantation (LDLT). We therefore examined the outcomes and the impact of WR on the postoperative course. MethodsWe analyzed 217 consecutive LDLT procedures performed from 2017 to 2022. We divided the recipients and donors into a WR group and non-WR group. ResultsTwenty-two recipients (10.1%) achieved WR (preoperative recipient WR [RWR] group), reducing their weight by 6.8% ± 6.0% within 2.2 ± 1.4 months with a significant decrease in body mass index (BMI) (p < 0.0001). The RWR group showed no significant differences in short-term postoperative outcomes (operative factors, postoperative liver function tests, amount of ascites, and morbidity) or in the graft survival rate as a long-term outcome (p = 0.24) compared with the non-RWR group. Forty-one (18.9%) donors achieved WR (preoperative donor WR [DWR] group), reducing their weight by 9.7% ± 6.3% within 3.2 ± 5.8 months with a significant decrease in BMI (p < 0.0001). Compared with the non-DWR group, the DWR group showed no significant differences in short-term postoperative outcomes between themselves and recipients or in the graft survival rate (p = 0.49). Furthermore, WR resulted in an increase to 32 donor-eligible and 6 recipient-eligible patients. ConclusionWR in LDLT recipients and donors had no harmful effect on postoperative outcomes and should lead to increase recipients’ chance of undergoing LDLT and to expand the donor pool.

Left Lobe First With Purely Laparoscopic Approach: A Novel Strategy to Maximize Donor Safety in Adult Living Donor Liver Transplantation.

Evaluate outcome of left-lobe graft (LLG) first combined with purely laparoscopic donor hemihepatectomy (PLDH) as a strategy to minimize donor risk. An LLG first approach and a PLDH are 2 methods used to reduce surgical stress for donors in adult living donor liver transplantation (LDLT). But the risk associated with application LLG first combined with PLDH is not known. From 2012 to 2023, 186 adult LDLTs were performed with hemiliver grafts, procured by open surgery in 95 and PLDH in 91 cases. LLGs were considered first when graft-to-recipient weight ratio ≥0.6%. Following a 4-month adoption process, all donor hepatectomies, since December 2019, were performed laparoscopically. There was one intraoperative conversion to open (1%). Mean operative times were similar in laparoscopic and open cases (366 vs 371 minutes). PLDH provided shorter hospital stays, lower blood loss, and lower peak aspartate aminotransferase. Peak bilirubin was lower in LLG donors compared with right-lobe graft donors (1.4 vs 2.4 mg/dL, P < 0.01), and PLDH further improved the bilirubin levels in LLG donors (1.2 vs 1.6 mg/dL, P < 0.01). PLDH also afforded a low rate of early complications (Clavien-Dindo grade ≥ II, 8% vs 22%, P = 0.007) and late complications, including incisional hernia (0% vs 13.7%, P < 0.001), compared with open cases. LLG was more likely to have a single duct than a right-lobe graft (89% vs 60%, P < 0.01). Importantly, with the aggressive use of LLG in 47% of adult LDLT, favorable graft survival was achieved without any differences between the type of graft and surgical approach. The LLG first with PLDH approach minimizes surgical stress for donors in adult LDLT without compromising recipient outcomes. This strategy can lighten the burden for living donors, which could help expand the donor pool.

Mapping early serum proteome signatures of liver regeneration in living donor liver transplant cases.

The liver is the only solid organ capable of regenerating itself to regain 100% of its mass and function after liver injury and/or partial hepatectomy (PH). This exceptional property represents a therapeutic opportunity for severe liver disease patients. However, liver regeneration (LR) might fail due to poorly understood causes. Here, we have investigated the regulation of liver proteome and phosphoproteome at a short time after PH (9 h), to depict a detailed mechanistic background of the early LR phase. Furthermore, we analyzed the dynamic changes of the serum proteome and metabolome of healthy living donor liver transplant (LDLT) donors at different time points after surgery. The molecular profiles from both analyses were then correlated. Insulin and FXR-FGF15/19 signaling were stimulated in mouse liver after PH, leading to the activation of the main intermediary kinases (AKT and ERK). Besides, inhibition of the hippo pathway led to an increased expression of its target genes and of one of its intermediary proteins (14-3-3 protein), contributing to cell proliferation. In association with these processes, metabolic reprogramming coupled to enhanced mitochondrial activity cope for the energy and biosynthetic requirements of LR. In human serum of LDLT donors, we identified 56 proteins and 13 metabolites statistically differential which recapitulate some of the main cellular processes orchestrating LR in its early phase. These results provide mechanisms and protein mediators of LR that might prove useful for the follow-up of the regenerative process in the liver after PH as well as preventing the occurrence of complications associated with liver resection.

Innovative formulae for the estimation of standard liver volume in the era of widespread imaging analysis software.

Various formulae have been used for the estimation of standard liver volume (SLV) in preparation for living donor liver transplantation (LDLT). However, these formulae have the disadvantage of being constructed using parameters that are substantially affected by the patient's condition. Here, we aimed to establish more precise formulae that are less affected by the general condition of the patient. We analyzed the liver volumes of LDLT donors and patients with normal livers (total: n=213) using the SYNAPSE VINCENT imaging analysis system, to develop new formulae. The accuracy of the new formulae were compared with those of existing formulae in a separate validation group of healthy patients (n=200). The new formulae were also validated using 81 LDLT recipients to assess their utility for graft selection in LDLT. Body surface area (BSA) and skeletal muscle mass index (SMI) independently affected total liver volume (TLV). We produced new formulae for SLV incorporating SMI: SLV = 32.2×L3-SMI-466.9 for men, with R2 .92, and 25.7×L3-SMI-55.97 for women, with R2 .79 (alongside a BSA formula with R2 .57), which provided the most accurate predictions of TLV in the validation group. A graft volume (GV)/SLV <.35, calculated using the new formulae, predicted the postoperative prognosis, including the development of small-for-size syndrome, sepsis, or acute rejection, significantly more effectively than GV/SLV using the previous formulae. The newly developed L3-SMI-based formula is more accurate for the estimation of SLV than previously reported formulae, and may thus help to improve the safety of LDLT.

Living donor liver transplant: A strategy to increase transplant access

Living donor liver transplant: A strategy to increase transplant access

Practice patterns and considerations in liver transplantation from living donors with high BMI: A review.

Living Donor Liver Transplantation (LDLT) is a valuable solution to the shortage of donor organs for patients with end-stage liver disease. However, the eligibility of obese donors for LDLT remains a subject of debate. This literature review explores global practices and perceptions of LDLT, identifies donor eligibility criteria, and discusses special considerations and ethical caveats. The review highlights the need for standardized guidelines for donor selection, considering the global distribution of Body mass index and variations in population-specific criteria. It also emphasizes the importance of non-invasive testing and pre-operative optimization of liver steatosis for select obese donors. Furthermore, the review examines the outcomes and complications associated with obese donors in LDLT. The findings of this review contribute to the ongoing discussion on the inclusion of obese donors in LDLT and provide insights for future research and guideline development.

Selection of Safe Donors for Living Donor Liver Transplant Using Extended Right Lobe Graft

Extended right lobectomy (ERL) for living donor liver transplant (LDLT) is selectively performed in many transplant centers and has shown excellent recipient outcomes as reported in previous studies. Yet, there is no universally accepted indication for ERL in respect to donor safety. Current study was designed to stratify risk factors of adverse donor outcome after ERL. A total of 79 living donors who underwent ERL for LDLT were included in analysis. Donors were classified as safety and hazard donor groups according to postoperative findings relevant to posthepatectomy liver failure classification by the International Study Group for Liver Surgery. On multivariable analysis, left lateral section volume <20% of total liver volume and nonpreservation of segment 4a venous drainage were the independent risk factors impairing postoperative outcomes. Despite the short-term impairment of liver function in hazard donor groups, all donors recovered and showed satisfactory remnant liver regeneration. However, these findings have implications in establishing selection criteria of donors eligible for ERL donation. In conclusion, LDLT using ERL graft can be safely performed provided so that left lateral section volume/total donor liver is ≥20% besides conventional donor selection criteria. Also, efforts to preserve segment 4a vein must be made in performing ERL graft procurement in LDLT donors.

Donor Skeletal Muscle Quality Affects Graft Mortality After Living Donor Liver Transplantation- A Single Center, Retrospective Study.

The recipient muscle status is closely associated with postoperative poor survival in recipients of living donor liver transplantation (LDLT). However, it is uncertain whether LDLT donor muscle quality and quantity affect graft quality. Hence, we analyzed the correlation between donor muscle status and graft function. We measured the skeletal muscle mass index (SMI) and intramuscular adipose tissue content (IMAC) of 380 LDLT donors. We examined the correlation between donor SMI or IMAC and graft mortality, the occurrence rates of small-for-size graft (SFSG) syndrome, and 6-month graft survival rates. The donor SMI had no effect on the occurrence of SFSG syndrome and graft survival, while a high IMAC in both male and female donors was significantly correlated with the rate of SFSG syndrome [high vs low: (male donors) 15.8% vs. 2.5%, p = 0.0003; (female donors) 12.8% vs. 3.1%, p = 0.0234] and 6-month graft survival rates [(male donors) 87.7% vs 95.9%, p = 0.02; (female donors) 83.0% vs. 99.0%, p < 0.0001]. Multivariate analysis revealed that a high donor IMAC (HR; 5.42, CI; 2.13-13.8, p = 0.0004) was an independent risk factor for 6-month graft survival, and the donor IMAC is useful for donor selection for high-risk recipients.

The Efficacy of Acoustic Radiation Force Impulse Elastography for Predicting Clinical Outcomes in Living Donor Liver Transplant

Acoustic radiation force impulse (ARFI) elastography is widely used for evaluating liver fibrosis. Here we evaluated the efficacy of ARFI elastography for estimating graft quality and clinical outcomes in living donor liver transplant (LDLT). We retrospectively evaluated the cases of 87 LDLT donors who preoperatively underwent ARFI elastography at Nagasaki University Hospital between August 2010 and June 2016. We analyzed whether the velocity of shear wave (Vs) obtained by ARFI elastography affected the regeneration rate of each donor's remnant liver and the 1-year survival rate of the recipients. There were no significant correlations between Vs value and the donors' age. Only 1 donor (1.1%) showed significant fibrosis, F2(portal fibrosis with few septa) in zero-biopsy. The 7 donors (8.0%), including 1 case, showed a high Vs value (>1.33) that was equal to F2, although there was no abnormal pathologic finding except in 1 case. In those cases, the regeneration rate of the remnant liver after hepatectomy was significantly lower compared to other cases. The 1-year survival rate of the recipients paired with the high-Vs donors was also significantly poorer than that of the other cases (high-Vs: 57.1%, others: 84.2%, P=.04). ARFI elastography might be an effective examination for the preoperative evaluation of the graft quality in LDLT.

Low syntaxin 17 expression in donor liver is associated with poor graft prognosis in recipients of living donor liver transplantation.

Liver transplantation (LT) is the only curative therapy for decompensated liver cirrhosis. For recipients of living donor LT (LDLT), restoration of liver function after transplantation is highly dependent on liver regenerative capacity, which requires large amounts of intracellular energy. Mitochondrial metabolism provides a stable supply of adenosine 5'-triphosphate (ATP) for liver regeneration. Mitophagy is a selective process in which damaged, non-functional mitochondria are degraded and replaced with new functional mitochondria. We investigated the relationship between expression of Syntaxin17 (STX17), a key protein in mitophagy regulation, in donor livers and graft survival. We examined STX17 expression in grafts from 143 LDLT donors who underwent right lobe resection and investigated the relationship between STX17 expression and graft function. We investigated the correlations among STX17 expression, mitochondrial membrane potential and cell proliferation, using a STX17-knockdown hepatocyte cell line. Recipients transplanted with low STX17-expression grafts had significantly lower graft survival rates than recipients transplanted with high STX17-expression grafts (88.9% vs. 100%, p<0.01). Multivariate analysis showed that low STX17 expression (HR: 10.7, CI: 1.29-88.0, p<0.05) and the absence of splenectomy (HR: 6.27, CI: 1.59-24.8, p<0.01) were independent predictive factors for small-for-size graft syndrome, which is the severe complication in LDLT. In the vitro experiments, the percentage of depolarized damaged mitochondria was increased in the STX17-knockdown hepatocyte cell line, suggesting decreased mitophagy and ATP synthesis. Cell proliferation was significantly decreased in the STX17-knockdown hepatocyte cell line. STX17 contributes to mitophagy and maintenance of mitochondrial function in hepatocytes and may be a predictor of graft dysfunction in LDLT patients.

Meta-analysis of donor–recipient gender profile in paediatric living donor liver transplantation

ObjectivePaediatric living donor liver transplantation (LDLT) has gained popularity due to limited deceased donor organ supply. Some studies report inequalities in donor and recipient gender profiles, but data are sparse....

Accuracy and Efficiency of Right-Lobe Graft Weight Estimation Using Deep-Learning-Assisted CT Volumetry for Living-Donor Liver Transplantation.

CT volumetry (CTV) has been widely used for pre-operative graft weight (GW) estimation in living-donor liver transplantation (LDLT), and the use of a deep-learning algorithm (DLA) may further improve its efficiency. However, its accuracy has not been well determined. To evaluate the efficiency and accuracy of DLA-assisted CTV in GW estimation, we performed a retrospective study including 581 consecutive LDLT donors who donated a right-lobe graft. Right-lobe graft volume (GV) was measured on CT using the software implemented with the DLA for automated liver segmentation. In the development group (n = 207), a volume-to-weight conversion formula was constructed by linear regression analysis between the CTV-measured GV and the intraoperative GW. In the validation group (n = 374), the agreement between the estimated and measured GWs was assessed using the Bland–Altman 95% limit-of-agreement (LOA). The mean process time for GV measurement was 1.8 ± 0.6 min (range, 1.3–8.0 min). In the validation group, the GW was estimated using the volume-to-weight conversion formula (estimated GW [g] = 206.3 + 0.653 × CTV-measured GV [mL]), and the Bland–Altman 95% LOA between the estimated and measured GWs was −1.7% ± 17.1%. The DLA-assisted CT volumetry allows for time-efficient and accurate estimation of GW in LDLT.

Impact of Monosegment Graft Use for Infants in Pediatric Living Donor Liver Transplantation

Left lateral segment grafts are generally used for very young pediatric patients undergoing living donor liver transplantation (LDLT). Recently, graft reduction techniques were developed for LDLT. Monosegment grafting has been used in newborns. The aim of this study was to determine the usefulness of monosegment grafting for infants. Recipients <2 years of age who underwent LDLT with a monosegment graft between 2010 and 2020 were gathered. Parents comprised all LDLT donors. A segment 2 monosegment graft was resected as a graft from the donor. Standard liver volume (SLV) was estimated using Urata's equation. Graft type, graft weight (GW), and native liver weight were assessed. Eight patients were included in the study. Original diseases consisted of biliary atresia (n=6) and fulminant hepatitis (n=2). Final graft type included monosegment (n=5) and reduced monosegment (n=3). Median final GW/body weight after reduction was 3% (range, 2%-3.4%). Median native liver weight/SLV was 134% except in patients with fulminant hepatitis. Median pre-reduction graft volume (GV)/estimated GV was 113% (range, 60%-208%). Median pre-reduction GV/SLV of monosegment grafts that required reduction (n=3) was 109% (range, 106%-121%). Median final reduced graft GV/SLV was 80% (range, 74%-91%). Complications due to large-for-size grafts were not observed. One case of bile leakage due to graft reduction occurred as a complication. Grafts were functioning well with the exception of one graft loss due to antibody-mediated rejection. Estimated GV in infants varies widely. Monosegment grafting can be useful for infants as well as newborns.

A meta-analysis on the incidence of donor-related depression after liver transplant.

Living donor liver transplantation (LDLT) is increasing, yet gaps exist in the understanding of psychological wellbeing of donors after liver transplant. This meta-analysis seeks to evaluate the incidence and risk factors for donor-related depression after liver transplantation. A search was conducted on Medline and Embase database. Articles assessing incidence of depression in LDLT donors were included. Incidence was pooled after Freeman-Turkey double-arcsine transformation. For risk factors, dichotomous variables were analyzed with generalized linear model, while a conventional meta regression with logit transformation was conducted for continuous variables. Of 1069 abstracts, 40 articles underwent full-text review. Seventeen articles were included. The pooled incidence of depression among 1888 LT donors was 7.66% (CI: 4.47-12.80%). Depression rates were significantly higher in Asian compared to Western studies (RR: 1.73, CI: 1.19-2.52, P = 0.0039). Female gender (P < 0.001), Caucasian ethnicity (P = 0.047), employment status (P < 0.001) and lower education levels (P = 0.044) were significantly associated with depression. Donor relationship with recipients was not a significant risk factor. LDLT remains a core aspect of the treatment of end-stage liver disease. However, the high depression rates after LT suggest that there remains room for improvement in the care of donors' mental health post-transplant.

A Comparison of Actual Graft Weight and Estimated Graft Volume Calculated with New Software Used for Anatomical and Volumetric Analysis of the Liver with Computed Tomography in Living Liver Donors

Objective: In the living donor liver transplantation (LDLT) context, accurate estimation of the graft weight to recipient weight ratio (GRWR) and future donor liver remnant volume by pre-operative volumetric analysis is very important. We aimed to compare the estimated graft volume (EGV) calculated with the LiverVision® software with the actual graft weight (AGW) measured in the back-table in this study. Material and Method: Patients who underwent right lobe LDLT and liver donors between 01.01.2018-30.05.2020 were retrospectively evaluated. Demographic data, body mass index, EGV, AGW and GRWR were recorded. Linear regression analysis, Pearson correlation coefficient and Bland-Altman plots were utilized for evaluation of the relationships between continuous variables. Results: A total of 108 liver donors were included in the study. The mean age of the donors was 32.6±8.8 years and mean EGV was 902.5±147.1 mL for all donors. The mean AGW was 890.6±145.9 g for all donors. A significant correlation was found between EGV and AGW for all donors (r=0.856, p&lt;0.001). The mean difference between EGV and AGW was 11.9±78.5 for all donors. 105 of the 108 (97.2%) measurements were within the 95% ranges of agreement between EGV and AGW according to the Bland-Altman plot. According to the regression model created to calculate the AGW, the formula AGW (g)=0.85xEGV (mL)+124.5 was obtained (r2 =0.732, p&lt;0.001). Conclusion: The liver volumes of the donors were successfully estimated with computed tomography (CT) with the newly developed Turkish semi-automatic LiverVision® software.

Living donor liver transplantation for Budd\u2012Chiari syndrome with right posterior segment graft and patch plasty using the superficial femoral vein: a case report

BackgroundIn living donor liver transplantation (LDLT) for patients with Budd‒Chiari syndrome (BCS), there are several concerns about reconstruction of the inferior vena cava (IVC) and hepatic veins. Herein, we report the case of a patient with BCS who underwent LDLT with right posterior segment graft (RPSG) and patch plasty for reconstruction of the hepatic venous outflow, using the patient’s own superficial femoral vein (SFV).Case presentationA 19-year-old man, who was diagnosed with primary BCS, underwent LDLT. His main hepatic veins were totally obstructed, and membranous stenosis was seen in the IVC. The LDLT donor was his mother; however, liver volumetric analysis showed that only her RPSG was appropriate. In the recipient surgery, 16 cm of the left SFV was harvested and was cut longitudinally and opened. The right hepatic vein (RHV) of the RPSG was anastomosed to the sidewall of the SFV graft. After explantation of native diseased liver was completed, the stenotic and thickened wall of the IVC was widely resected, and a large anastomotic orifice was created. Patch cavoplasty was performed with the RHV‒SFV graft patch. After portal reperfusion started, hepatic venous outflow was satisfactory, and there was no venous graft congestion. Both his postoperative course and his long-term course after discharge were uneventful.ConclusionsIn LDLT for BCS patients, ingenuity is required for the reconstruction of venous outflow. The SFV patch can be safely harvested from liver transplant recipients and is suitable for venous reconstruction. In addition, RPSG is an alternative type of liver graft for LDLT if a conventional right- or left-lobe graft cannot be used.

A Rare Case Report: Hemodynamic Responses and Exercise Capacity Before and After Becoming a Non-Biological Live Liver Donor

Background: According to the United States Department of Health and Human services 8,497 liver transplants were accomplished in the United States in 2016. Of those transplants, only 345 (4.1%) of the transplants came from a live donor and only 9 (0.03%) of the live donor transplants came from a nonbiological paired donor [1]. Very little published data exists regarding Living Donor Liver Transplant (LDLT) influences on the live donor’s responses to exercise post-surgery. Purpose: To study the acute and prolonged effects of exercise and LDLT on heart rate, blood pressure, Lactate, Glucose, estimated maximal aerobic capacity, muscular strength, and the responses during submaximal exercise testing (6MWT and/or submaximal Bruce protocol). Methods: A single female subject, age 53 years, volunteered to participate in this study after already agreeing to become a live liver donor. Data was obtained once prior to the procedure and every month thereafter, for a total of eight months post-surgery. Conclusions: There was minimal changes in aerobic capacity and strength due to lack of consistency with an exercise program. Findings of this case report cannot be generalized to all LDLT donors. However, the information on the recovery of an LDLT donor in respect to exercise testing may be beneficial to clinicians and professionals in prescribing an exercise program for similar patients in similar circumstances.

EFFECT OF PRE-TRANSPLANT SARCOPENIA ON THE ESTIMATION OF THE STANDARD LIVER VOLUME IN LIVING-DONOR LIVER TRANSPLANT CANDIDATES

Background: The most commonly used formula for estimation of the standard liver volume (SLV) in living-donor liver transplantation (LDLT) candidates, are body weight (BW)-based. However end-stage liver disease causes a significant modification of the body mass composition, making BW an unreliable anthropometric parameter. The aim of the study was to investigate whether LT candidates with sarcopenia are at an increased risk of receiving an inappropriate SLV estimation by standard BW-SLV formula. Patients and Methods: Non-BW-SLV estimation formulas were tested in 262 LDLT donors and compared to a standard BW-SLV formula. The anthropometric parameters used were the thoracic width (TW-SLV) and thoracoabdominal circumference (TAC-SLV). Subsequently, sarcopenic and non-sarcopenic LDLT candidates (total, 217 patients) were compared in terms of estimated BW-SLV and non-BW-SLV. The prognosis in patients with sarcopenia, a small for size syndrome (SFSS) was evaluated. Results: In donors, TW-SLV showed comparable concordance with CT scan measured total liver volume as BW-SLV (rho 0.61 and 0.67, respectively). The performance of TAC-SLV was low (rho 0.34). In recipients, the prevalence of pre-LT sarcopenia was 30.4%. Sarcopenic patients were attributed to significantly lower BW-SLV than controls (sarcopenia vs controls, 1063.8ml [1004.1-1118.4] vs 1220.7ml [1115.0-1306.6], p<0.001), despite comparable TW-SLV, age, body high and gender prevalence. As a result, sarcopenic patients received a graft with a statistically lower weight at organ procurement (429g [353-532] vs 472g [400-603], p 0.02), and developed more frequently a SFSS according to the Dahm et al. (27.7% vs 6.8%, p<0.01) and Kyushu (28.7% vs 9.2%, p<0.01) definition. There was significantly worse prognosis wit SFSS than without SFSS besides there were no significant differences of survival between with and without sarcopenia. Conclusion: In sarcopenic patients, BW-SLV formulas are affected by a high risk of SLV underestimation, thus exposing them to an increased risk of post-LT SFSS.

Clinical Features and Long-Term Outcomes of Living Donors of Liver Transplantation Who Developed Psychiatric Disorders.

BackgroundIn the field of living donor liver transplantation (LDLT), it is important to ensure donor’s psychological well-being. We report on clinical features and long-term outcomes of LDLT donors who developed psychiatric disorders after their donor operations. Additionally, we compare patient backgrounds, as well as surgical and perioperative aspects between LDLT donors with and without postoperative psychiatric complications.Material/MethodsBetween November 1998 and March 2018, we identified 254 LDLT donors at our hospital. Among these, we investigated those who had newly developed psychiatric complications and required psychiatric treatment after donor operation.ResultsThe median duration of follow-up was 4 years. Sixty-five donors were lost to follow-up. Eight donors (3.1%) developed postoperative psychiatric complications, including major depressive disorder in 4, panic disorder in 2, conversion disorder and panic disorder in 1, and adjustment disorder in 1. The median duration from donor surgery to psychiatric diagnosis was 104.5 days (range, 12 to 657 days) and the median treatment duration was 18 months (range, 3 to 168 months). Of those, 3 donors required psychiatric treatment over 10 years, and 4 donors remained under treatment. The duration of hospital stay after donor operation was significantly longer and perioperative complications with Clavien classification greater than grade IIIa were more frequent in donors with psychiatric complications than in those without psychiatric complications (P=0.02 and P=0.006, respectively).ConclusionsAccurate diagnosis and appropriate treatment for psychiatric disorders by psychiatrists and psychologists are important during LDLT donor follow-up. Minimization of physiological complications might be important to prevent postoperative psychiatric complications in LDLT donors.

P.104: Donor morbidity following living donor liver transplantation: A single small volume center experience.

Background: Living donor liver transplantation (LDLT) has being increasingly performed to alleviate the shortage of cadaveric liver graft. The main disadvantage of this procedure is the risk of complications or even death in a healthy donor who does not derive any medical benefits from the operative procedure. We present the experience of donor morbidity following LDLT at Dong-A University Medical Center for five years. Methods: From Jan. 2014 to Mar. 2019, 53 LDLTs and 47 deceased donor LT were performed at our hospital. Donor demographics, graft type, complications, length of stay and overall survival were evaluated. Donor morbidity was assessed objectively using the modified Clavien-Dindo classification. Results: There were 48 cases of right lobe graft, 2 cases of left graft, 1 left lateral graft for pediatric patient and 2 cases of dual grafts (two left lobe). Median follow-up was 31.1 months. Mean donor age, donor BMI and hospital stay were 25.6 years, 21.5 kg/m2 and 11.4 days. There was no donor mortality. Grade II complications were observed in 2 (3.7%), Grade IIIa in 4 cases and IIIb in 1 case were developed in 5 (9.4%). All donor morbidities except Grade I complications was 7/53(13.2%). Conclusions: Although small cases, our experience shows that donor hepatectomy for living donor liver transplantation is a safe procedure in a small volume center. Our donor morbidity of 13.2% is comparable to most high-volume centers across the world. Meticulous preoperative evaluation, careful operation and proper remnant volume are guarantee for the safety of donors in LDLT.