Lobe Liver Graft Research Articles

Living Donor-Initiated Domino Split-Liver Transplantation in Pediatric Setup: A Case Report With Literature Review

In patients undergoing liver transplantation for metabolic diseases, removing the patient's liver for transplantation to another recipient is called "domino liver transplantation." The extracted liver can be divided and transplanted into 2 recipients, which is called domino split-liver transplantation in the literature. However, in our study, the domino liver was obtained from a pediatric patient. A patient with maple syrup urine disease (MSUD) underwent a living donor liver transplant, and the explanted liver was divided in situ into right and left lobes and transplanted to 2 separate patients. Demographic data, surgical techniques, postoperative period, and patient follow-ups were evaluated. The father's left lobe liver graft was transplanted into a 12-year-old boy with MSUD. The removed liver was divided in situ into right and left lobes. The left lobe was transplanted to a 14-year-old male patient, whereas the right lobe was transplanted to a 67-year-old male patient. The donor and the first recipient were discharged on postoperative days 5 and 22. The second pediatric patient who underwent domino split-left lobe transplantation was discharged on postoperative day 23. The adult patient who underwent domino split-right lobe transplantation died on postoperative day 12 owing to massive esophageal variceal bleeding. Patients who underwent liver transplantation due to MSUD are among the best donor choices for domino liver transplantation. If the extracted liver has a sufficient volume and anatomic features for a split, it can be used in "selected cases."

Anesthesia Management in Laparoscopic Donor Hepatectomy: The First Report from Turkey

We aimed to report a single-center experience in laparoscopic donor left-side and right-side hepatectomy cases regarding preoperative evaluation, perioperative and anesthetic management protocols, and postoperative follow-up. Laparoscopic donor left-side and right-side hepatectomy cases were included in the study because of their excessive transection area and bleeding potential. Medical records of living donors were reviewed in terms of age, sex, body mass index (BMI), presence of consanguinity with the recipient, perioperative and early postoperative biochemical parameters, hemodynamic changes during surgery, duration of surgery, the ratio of liver volume to total liver volume, perioperative complications, and length of hospital stay. Eighty-one laparoscopic living-donor hepatectomy procedures were performed in our unit between 2018 and 2022. Six laparoscopic donor right-side cases and two left-side cases were retrospectively reviewed. Donors' mean age and BMI were 29.6 ± 8.6 years and 23.1 ± 4.3, respectively. The average weights of the right and left lobe liver grafts were 727 g and 279 g, respectively, constituting 65.8% and 22.7% of the total liver volume, respectively. The mean operation time was 593 ± 94 minutes, and the mean volume of blood loss was 437 ± 294 mL. A major complication, namely portal vein stenosis, developed in 1 donor (1/8), and portal vein patency was achieved postoperatively. Anesthesia management and teamwork between surgeons and anesthesiologists are the most important building blocks for donor safety, which is of the utmost priority. Effective communication and cooperation in the operating room may prevent potential donor complications and improve postoperative recovery time.

Accuracy of preoperative liver volumetry in living donor liver transplantation—A systematic review and meta-analysis

BackgroundLiver volume measurement plays a critical role in the clinical success of living donor liver transplantation (LDLT). CT liver volumetry is used for volumetric assessment of the donor hepatectomy. However, the degree of accuracy of the preoperative predicted volumetric measurements remains unclear. PurposeThis systematic review will assess the accuracy of CT liver volumetry. Materials and MethodsA systematic literature search was conducted to evaluate the accuracy of the CT based liver volumetry. To assess the difference between the left and right liver lobe the ratio between preoperative estimated graft volume (EGV) and actual graft weight (AGW) was calculated. A meta-analysis was performed to compare the EGV to the AGW of the left and right lobe with automated and manual CT volume prediction. ResultsThirty-one studies met the inclusion criteria and 1336 patients were included in the meta-analysis. The EGV of the right liver is overestimated with a mean of 4.01% and 2.99% for automated and manual volumetry respectively. The left lobe is overestimated with 6.28% and 14.41% for automated and manual volumetry respectively. For a right lobe liver graft automated volume prediction showed a mean difference of 43.9 g (95% confidence interval (CI): 21.21–66.54, p<0.001) between EGV and AGW. For manual volume prediction this was 34.0 g (95% CI: 11.85–56.11, p = 0.003). For a left lobe with automated volume prediction the mean difference was 46.0 g (95% CI: 20.91–71.09, p<0.001) between EGV and AGW. For manual volume prediction this was 39.6 g (95% CI: 8.40–70.74, p = 0.01). ConclusionThe volumes of the right and left liver lobe seem to be overestimated with automated and manual CT volume prediction. Considering the larger estimation error in the prediction of the left liver lobe, special attention should be paid to the volume when performing a LDLT with a left liver lobe to prevent small for size syndrome.

Selective use of hemi-portocaval shunt to optimise portal pressure in small-for-size right lobe liver grafts is the key to successful transplantation: a validation study

Selective use of hemi-portocaval shunt to optimise portal pressure in small-for-size right lobe liver grafts is the key to successful transplantation: a validation study

The importance of Inferior Hepatic vein reconstruction in right lobe liver grafts: Does it really matter?

BackgroundReconstruction of large IHV is mandatory to preserve graft outflow. However, outcome of small IHV reconstruction is not known as they often get blocked postoperatively. We therefore retrospectively analysed the role of IHV reconstruction and compared outcome of smaller IHV to ascertain role in graft alignment and improving graft outflow. MethodsAll patients receiving RLG from January,2014 to September,2019 were reviewed. Patients were classified in two groups-grafts without IHV reconstruction(Group RV) and with IHV reconstruction(Group IRV). Small IHVs were compared between two group according to their postoperative patency. ResultsThere was no difference between two groups (Group IRV, n = 430, Group RV, n = 795) in pre/intra-operative variables except ischemia times. However, Clavien Dindo grade 3 complications, RHV occlusion and mortality were significantly higher in group RV. 55.1% of small IHVs were blocked in the postoperative period. However, there was no difference in outcome between blocked and patent IHVs. ConclusionOutcome of liver grafts with IHV reconstruction was better than those without IHV reconstruction. RHV occlusion was also significantly lower with IHV reconstruction which may explain the role of better positioning of the graft and preventing outflow obstruction. IHVs should preferably always be reconstructed and even they get blocked may improve overall outcome by maintaining graft in true orthotopic position.

Reliability of CT volumetry as a tool to calculate the preoperative donor liver volume: Correlation with the intraoperative graft weight in living donor liver transplantation (LDLT)

Liver transplantation has become an ideal management for end stage liver diseases. The preoperative volumetric assessment of donor liver is an important factor in determining the surgical strategy and in predicting post operative donor and recipient mortality and morbidity. CT has high spatial and contrast resolution and provides comprehensive parenchymal vascular and volumetric preoperative evaluation of donor undergoing live donor liver transplant and its accuracy can be established by comparing it with the intraoperative actual graft volume.52 patients who underwent donor right hepatectomy were included in the study and underwent CT scanning during the period from July 2017 to June 2019. Manual tracing of CT volumetry was done for calculating liver volume. The actual liver volume is obtained by weighing the graft immediately after resection. The difference between preoperative CT volume and intraoperative graft weight was defined as a percentage error ratio, which was classified as overestimation (+) and underestimation (-).In 28 (53.8%) cases, right lobe liver grafts obtained including MHV, whereas in 24(46.2%) cases right liver lobe grafts obtained excluding MHV. The mean preoperative liver volume calculated was 816.5+ 142.5g, while the mean volume measured intraoperatively was 812.6 g + 136.8g. The mean volume difference between preoperative and actual graft volume was 51.96+33.65cm(range 4-131cm). The mean error ratio was 6.59+4.623%. 30(57.7%) cases had underestimation, whereas 22(42.3%) cases had overestimation of liver volume. The mean preoperative volume had a good correlation with actual graft volume.The present study concludes that CT volumetry accurately predicted preoperative graft volume and showed excellent correlation with actual graft volume.

DOES THE COLD STORAGE REALLY «COLD»? LIVER THERMOGRAPHY AND MICRODIALYSIS FINDINGS

Background: We suggest that in clinical practice organ temperature (Temp) during static cold storage is an underestimated factor affecting both the organ metabolic state before transplantation and the initial graft function. To verify this hypothesis we conducted a pilot clinical study involving living (LD) and deceased donors (DD) liver grafts. Material and Methods: The study included 4 LD right lobe liver grafts (cases L1 – L4) and 7 grafts from standard criteria DD with brain death (cases D1 – D7). Two DD grafts were not transplanted due to prolonged cold ischemia time (CIT) exceeding 13 hours (cases D6 and D7). Histidine-tryptophan-ketoglutorate solution was used for all grafts. Thermography (Guide D160) and microdialysis (M Dialysis AB, Sweden) were performed in each case at the end of the CIT. Microdialysis catheter was placed in SIV (for DD) or in SVIII (for LD). Samples of interstitial fluid were collected within 30-45 minutes before thermography and analysed for glucose (Glu), lactate (Lac), pyruvate (Pyr) and glycerol (Glyc). All transplantations were primary, non-urgent, performed in patients with cirrhosis and MELD value of 12-24 points.Early allograft dysfunction (EAD) was diagnosed with Olthoff criteria. There were no primary non-functioning grafts. Results and Discussion: CITs for LD grafts were: 0,5 – 1,0 h (median–0,5); for all DD grafts: 8,0 – 14,0 h (median–11,0) and for DD transplanted grafts: 8,0 – 12,5 (median–9). The medians of Temp [T(med)] were significantly higher than 4°C and varied widely. For LD: 13.4°C - 16.8°C, for DD: 7.7°C - 12.4°C. Moreover, the Temp of each individual graft also varied widely: the difference between the hottest and coldest points was in the range of 3.5°C – 7.3°C.At the end of CIT the Temp of DD grafts with normal initial function (D1, D2 and D3) were significantly lower than in grafts with EAD (D3 and D4): 8,5 [7,8 – 10,1](6,6 – 12,0) vs. 12,1 [11,5 – 12,7](9,2 – 15,7), p = 0.005. In addition to the level of Glyc, there were no other significant differences in microdialysis parameters between DD and LD grafts.This was probably due to a strong correlation between Glyc level and CIT: Spearman R = 0,96; p <0,001. Based on the suggesting that not only CIT but also T(med) affects the graft metabolic state immediately before transplantation, a new variable was introduced: [CIT * T(med)] (hours * °C). Apparently, the relationship of this parameter with interstitial levels of Glu, Lac, and Glyc was nonlinear. The best results of dynamic fitting in all cases were achieved using the equation: f = y0+a*exp(b*x). The R2 values for Glu, Lac and Glyc were 0,80, 0,60 and 0,81, respectively.Conclusion: Our results confirm the strong influence of Temp on the state of metabolism in the graft and its initial function. The development of devices for continuous assessment of metabolic state and Temp control during cold storage is promising. Russian Science Foundation (grant # 19-75-10040).

Is right lobe liver graft without main right hepatic vein suitable for living donor liver transplantation?

Is right lobe liver graft without main right hepatic vein suitable for living donor liver transplantation?

Is right lobe liver graft without main right hepatic vein suitable for living donor liver transplantation?

Is right lobe liver graft without main right hepatic vein suitable for living donor liver transplantation?

Adult living donor liver transplantation from donors with Gilbert's syndrome: Is it safe?

We evaluate whether it is safe to accept donors with Gilbert's syndrome (GS) for a living donor liver transplantation (LDLT) or not. This study is the first controlled study to be conducted. Between January 2004 and May 2014, 600 LDLTs which used right lobe liver grafts were performed in our center. Forty-five of the 600 donors had a GS diagnosis. For a control group, 99 donors without GS who had completed 1year or more of follow-up were selected retrospectively and consecutively. The clinical results of the donors and recipients were then analyzed. A total of 45 donors with GS and 99 donors without GS were included. There were no significant differences in patient demographics, actual graft weight, remnant ratio, portal and ductal variations, pre-peri-post-operative liver enzymes. The donors with GS had significantly higher bilirubin levels compared with the control group at first reading, at maximal peak, and post-operative 1-7days, 1st and 6th months (P<.001 for all readings). Post-operative complication ratio was 40% in GS, 34.3% in non-GS group. In GS and non-GS group, hospitalization period was 10.2 and 9.2days, respectively. The 1-year donor survival rate was 100% for both groups and 1-year recipient survival was similar who have donors with GS and non-GS (93.3%; 92.9%, P=.93). The use of right lobe grafts from donors with GS appears to be safe for donor health.

Features of right lobe liver transplantation from living related donor

Aim. To determine the peculiarities of liver transplantation using right lobe graft from living related donor with and without the middle hepatic vein inclusion.Materials and methods. The study has analyzed preoperative, intraoperative and postoperative data of 76 recipients who underwent right lobe living donor liver transplantation with different types of hepatic vein reconstruction: group 1 – patients who received a right lobe liver graft with a middle hepatic vein, and group 2 – recipients of right lobe liver graft without the middle hepatic vein. For comparative analysis, we used biochemical and regional hemodynamic parameters in both groups during the first week and on days 10, 14, 21 and 30 after transplantation.Results. In group 1, the higher values of Qpv – 649 ± 220 ml/min, 1222 ± 491 ml/min; 1264 ± 372 ml/min; 1166 ± 284 ml/min; 1016 ± 211 ml/min; 1095 ± 301 ml/min were observed compared to group 2 – 643 ± 230 ml/min; 1127 ± 385 ml/min; 1132 ± 372 ml/min; 1030 ± 263 ml/min; 980 ± 254 ml/min; 922 ± 293 ml/min on days 0, 1, 3, 5, 7 and 30 after transplantation, respectively, (P &lt; 0.05). Peak systolic velocity (PSV) and resistance index of hepatic artery (RIha) were increased to higher values in group 2 (from 0.54 m/s to 0.69 m/s and from 0.63 to 0.69, respectively, P &lt; 0.05) compared to group 1 (from 0.58 m/s up to0.62 m / s and from 0.62 to 0.69, respectively, P &lt; 0.05). In the postoperative period, the level of total bilirubin in group 1 (grafts with middle hepatic vein) was significantly lower and the level of transaminases was higher than in group2. In the group of recipients, who had a graft with middle hepatic vein, the frequency of small-for-size syndrome (SFSS) was lower compared with group 2 (17.94 % vs 27.00 %, P &lt; 0.05).Conclusions. When performing the right lobe liver transplantation, the middle hepatic vein presence in the graft is correlated with a decrease in the frequency of postoperative complications and small for size syndrome development. Adequate venous outflow with sufficient volume of right lobe liver graft determines the functional graft mass.

Analysis of Risk Factors Affecting the Development of Infection in Artificial Vascular Grafts Used for Reconstruction of Middle Hepatic Vein Tributaries in Living Donor Liver Transplantation.

To analyze the risk factors affecting the development of infection in artificial vascular grafts (AVGs) used for reconstruction of middle hepatic vein (MHV) tributaries in living donor liver transplantation (LDLT). Between January 2009 and January 2018, 1253 right lobe LDLTs were performed at our Transplant Institute, and MHV tributaries of the 640 right lobe liver grafts were reconstructed with AVG. Reconstructed MHV tributaries were removed due to AVG infection in 25 of these patients (case group; n = 25). To determine risk factors for AVG infection, right lobe LDLT patients without AVG infections were selected as control group (n = 615). Both groups were compared about demographic parameter, transcystic catheter usage, bile leakage, type of biliary anastomosis (duct-to-duct, telescopic duct-to-duct), number of graft biliary duct (=1 versus >1), number of biliary anastomosis (=1 versus >1), AVG thrombosis, AVG types (Dacron versus polytetrafluoroethylene). Univariate analyses were used for comparison of different variables, and variables with P ≤ 0.20 were taken into logistic regression model. Univariate analysis shows that statistically significant differences were found between groups regarding bile leakage (P < 0.001), graft thrombosis (P = 0.002), transcystic catheter (P = 0.049), and AVG types (P = 0.013). Variables with P ≤ 0.20 were taken into logistic regression model. Multivariate analysis shows that bile leakage (odds ratio, 13.3) and AVG thrombosis (odds ratio, 9.8) were determined as independent and strong risk factors for development of AVG infection. This study revealed that bile leakage and graft thrombosis are independent and strong risk factors for infections of AVGs used for anterior sector drainage reconstruction.

Percutaneous Transhepatic Biliary Drainage for Biliary Stricture After Endotherapy Failure in Living Donor Liver Transplantation: A Single-Centre Experience from India

In the living donor liver transplant (LDLT) population, postoperative biliary stricture is a common problem. Endoscopic retrograde cholangiography (ERCP) and stenting failures usually occur because of odd angulation of the ducts, particularly in right lobe grafts. Percutaneous transhepatic biliary drainage (PTBD) is helpful in patients where endoscopic intervention is unsuccessful. We report our experience in this particular group of patients from India. We analysed retrospective data of 932 patients who underwent LDLT at our centre. Data collected includebasic demographics, technical and clinical success rate of PTBD, postprocedure complications and overall outcome. Of the 932 patients, 81 (8.7%) developed biliary stricture and required endoscopic or percutaneous interventions; out of whom, 75 patients underwent ERCP, and 6 patients had hepaticojejunostomy. Right posterior sector graft recipients had the highest incidence of biliary stricture (29.16%), followed by the right lobe grafts (8.57%), whereas stricture rate was less among left lobe and left lateral lobe graft recipients (3.77% and 3.7%, respectively). Failure of ERCP was common among the ductoplasty group (80%). The failure rate of ERCP did not differ significantly among patients who had single-duct, two-duct or three-duct anastomoses (44%, 36% and 50%, respectively, p > 0.05). PTBD was technically successful in 34 patients (87%) The mortality rate following PTBD was 2.5%, and morbidity was 15%. For the 5 patients in whom PTBD could not be performed, open hepaticojejunostomy was performed successfully. Right lobe liver grafts have high incidence of biliary stricture compared with left lobe grafts. The failure of ERCP was not dependent on the number of biliary anastomoses; however, the ductoplasty group had a higher failure rate. PTBD is technically successful in a majority of patients albeit with a morbidity of 15%. Open hepaticojejunostomy is a good therapeutic option following PTBD failure.

Living donor liver transplantation using right lobe graft from a donor with the left-sided gallbladder anomaly

Introduction: The occurrence of left-sided gallbladder in the absence of situs inversus is a rare congenital anomaly. It is characterized by a complex liver structural abnormalities, including the presence of a right-sided falciform ligament, atrophy or agenesis of segment 4, absence of extrahepatic bifurcation in some occasion and abnormal intrahepatic branching patterns of the portal vein. Method: case: A 34-year-old blood-type AB Rh+ son donated right lobe to his mother (blood type B Rh+) with B-viral hepatitis and hepatocellular carcinoma. Preoperative CT was performed, and left-sided gallbladder anomaly was found in the donor liver. 3D analysis using Synapse 3D revealed right sided umbilical ligament, intrahepatic bifurcation of the portal vein and a long common trunk of P2 and P3. Result: Intraoperatively, cholangiography was performed after cholecystectomy via cystic duct and findings identical to the MR cholangiography was obtained. After hanging, the hepatic transection plane was kept to the left of the falciform ligament to prevent damage to the main intrahepatic portal trunk, using CUSA. The main trunk of middle hepatic vein was left to the donor and the V5 and V8 were temporarily ligated with hemolock clips for later reconstruction during bench procedure. The liver transection was otherwise, uneventful and the right portal vein, right hepatic artery and right duct were ligated separately. After right hepatic vein ligation, the graft was procured with the falciform ligament, and flushed with cold HTK solution as in our standard practice. There was no complication in donor. The left portal vein showed no disturbance in flow. The graft showed excellent function and the recipient recovered successfully. Conclusion: We have shown that it is technically feasible to retrieve the right lobe liver grafts from living donor without complication.

Readdressing the Middle Hepatic Vein in Right Lobe Liver Donation: Triangle of Safety

For equipoising donor safety and optimal recipient outcomes, we adopted an algorithmic "triangle of safety" approach to retrieve 3 types of right lobe liver grafts (RLGs), namely, the modified extended right lobe graft (MERLG), the partial right lobe graft (PRLG), and the modified right lobe graft (MRLG). Reconstruction to achieve a single wide anterior sector outflow was ensured in all patients. We present donor and recipient outcomes based on our approach in 665 right lobe (RL) living donor liver transplantations (LDLTs) performed from January 2013 to August 2015. There were 347 patients who received a MERLG, 117 who received a PRLG, and 201 who received a MRLG. A right lobe graft (RLG) with a middle hepatic vein was retrieved only in 3 out of 18 donors with steatosis >10%. Cold ischemia time was significantly more and remnant volume was less in the MRLG group. Of the donors, 29.3% had complications (26% Clavien-Dindo grade I, II) with no statistically significant difference among the groups. The Model for End-Stage Liver Disease score was higher in the MERLG group. There were 34 out of 39 with a graft-to-recipient weight ratio (GRWR) of <0.7% who received a MERLG with inflow modulation. Out of 4 patients who developed small-for-size syndrome in this group, 2 died. The 90-day patient survival rate was similar among different GRWRs and types of RLG. In conclusion, a selective and tailored approach for RL donor hepatectomy based on optimal functional volume and metabolic demands not only addresses the key issue of double equipoise in LDLT but also creates a safe path for extending the limits.

Selection of the right lobe liver graft from living family donor

Selection of the right lobe liver graft from living family donor

Doppler Ultrasound in the Diagnosis of Portal Vein Stenosis in Adult Living Donor Liver Transplant with Left Lobe Liver Grafts

Objectives: Our aim was to identify ultrasound criteria that may be used to detect portal vein stenosis (PVS) in adult living donor liver transplantation (ALDLT) with left lobe grafts. Keywords: Doppler ultrasound, left liver graft, living donor liver transplantation, portal vein stenosis.

Ad Integrum Functional and Volumetric Recovery in Right Lobe Living Donors: Is It Really Complete 1 Year After Donor Hepatectomy?

The partial liver's ability to regenerate both as a graft and remnant justifies right lobe (RL) living donor liver transplantation. We studied (using biochemical and radiological parameters) the rate, extent of, and predictors of functional and volumetric recovery of the remnant left liver (RLL) during the first year in 91 consecutive RL donors. Recovery of normal liver function (prothrombin time [PT] ≥70% of normal and total bilirubin [TB] ≤20 µmol/L), liver volumetric recovery, and percentage RLL growth were analyzed. Normal liver function was regained by postoperative day's 7, 30, and 365 in 52%, 86%, and 96% donors, respectively. Similarly, mean liver volumetric recovery was 64%, 71%, and 85%; whereas the percentage liver growth was 85%, 105%, and 146%, respectively. Preoperative PT value (p = 0.01), RLL/total liver volume (TLV) ratio (p = 0.03), middle hepatic vein harvesting (p = 0.02), and postoperative peak TB (p < 0.01) were predictors of early functional recovery, whereas donor age (p = 0.03), RLL/TLV ratio (p = 0.004), and TLV/ body weight ratio (p = 0.02) predicted early volumetric recuperation. One-year post-RL donor hepatectomy, though functional recovery occurs in almost all (96%), donors had incomplete restoration (85%) of preoperative total liver volume. Modifiable predictors of regeneration could help in better and safer donor selection, while continuing to ensure successful recipient outcomes.

LIVER TRANSPLANTATION IN CHILDREN: SIX-YEAR EXPERIENCE ANALYSIS

Introduction . Over the past few decades in Russia and other countries there has been signifi cant progress in the development of liver transplantation in children. It became possible to operate recipients with very low body mass, to perform transplant from cadaveric and living donors with incompatible blood type, as well as to perform single-step transplantation of liver with kidney or pancreas in patients with combined diseases. Aim: to investigate the 6-year experience of liver transplantation in children in V.I. Shumakov Federal Research Center of Transplantology and Artifi cial Organs. Materials and methods. From May 2008 to June 2014 304 liver transplants were performed in 297 children aged from 3 months to 17 years with body mass 4 to 32 kg. 241 living donor liver left lateral section transplants (including 2 in conjunction with kidney), 8 left lobe (including 1 in conjunction with kidney), 40 right lobe liver transplants (including 1 in conjunction with kidney), and 9 cadaveric whole liver transplants (including 1 case of simultaneous liver and pancreas transplantation) and 6 split liver transplants (4 – split left lateral section transplantations and 2 extended right lobe liver grafts) were achieved. 41 of these patients received a graft from AB0 – incompatible donors. Results . A retrospective evaluation of surgical technique and analysis of results were carried out. Early mortality was 8.1%, 1-year survival rate – 86.4%, 5-year survival rate – 78.8%. Conclusion. These results suggest the prospects of this procedure for pediatric transplantation and require further investigation and promotion approaches in medical and social public.

Results of Surgery-Related Complications in Donors of Right Lobe Liver Graft: Analysis of 272 Cases

BackgroundLiving donor liver transplantation has been a new light of hope for patients with end-stage liver failure on the cadaveric waiting list. However, living donor liver transplantation still has ethical problems which cannot be overcome. Exposure of healthy donor candidates to major surgery which can be fatal is the largest of these ethical problems. In this study, we aimed to determine our rate of complications associated with surgery in donors who underwent right lobe donor hepatectomy. Materials and MethodsBetween September 2004 and December 2009, 548 liver donor candidates were examined. The right liver lobe donor hepatectomy was performed on 272 donor candidates who passed the elimination system. Demographic data as well as intraoperative findings, complication rates, and numbers were collected retrospectively. Donor complications were categorized according to the Clavien classification. ResultsTwo hundred seventy-two donors who underwent right lobe donor hepatectomy were included in this study. One hundred sixteen (42.6%) of 272 donors were female, whereas 156 (57.4%) were male. There was no donor mortality. Grade 1 and grade 2 complications were observed in 105 (38%) of 272 donors. The most common complications were fever of unknown origin (20.9%) and prolonged hyperbilirubinemia (3.6%). Grade 3 complications and grade 4 complications were observed in 6 donors (2%) and 3 donors (1%), respectively. Three donors were underwent re-operation due to bleeding. The re-laparatomy rate in our series was detected as 1.10%. One donor, categorized as grade 4B according to the Clavien classification, had small bowel perforation and intra-abdominal sepsis secondary to mechanical bowel obstruction. ConclusionsDonor mortality is a fact of living donor liver transplantation that cannot be ignored like donor morbidity. However, right liver lobe donor hepatectomy can be performed successfully with minimal complication rates with multidisciplinary and rigorous donor care in the preoperative and postoperative period.