Donor safety in living donor liver donation: An Italian multicenter survey

Background: Major concerns about donor morbidity and mortality still limit the use of living donor liver transplantation (LDLT) to overcome the organ shortage. Methods: The present study assessed donor safety in LDTL in Italy reporting donor postoperative outcomes in 246 living donation procedures performed by seven transplant centers. Outcomes were evaluated over two time periods using the validated Clavien 5-tier grading system, and several clinical variables were analyzed to determine the risk factors for donor morbidity. Results: Different grafts were obtained from the 246 donor procedures (220 right lobe, 10 left lobe, and 16 left lateral segments). The median follow-up post-donation was 112 months. There was no donor mortality. One or more complications occurred in 82 donors (33.3%), and three of them had intraoperative complications (1.2%). Regardless of graft type, the rate of major complications (grade≥III) was 12.6% (31/246). The overall donor morbidity and the rate of major complications did not differ significantly over time: 25 donors (10.2%) required hospital readmission throughout the follow-up period, while 5 donors (2%) required reoperation. Prolonged operative time (>400 min), intraoperative hypotension (systolic 300 mL) were multivariate risk factors for postoperative donor complications. Conclusion: From the standpoint of living donor surgery, a meticulous and well-standardized technique that reduces operative time and prevents blood loss and intraoperative hypotension may reduce the incidence of donor complications. Transparency in reporting results after LDLT is mandatory and we should continue to strive for zero donor mortality. This article is protected by copyright. All rights reserved.