L/I‐12 Living donor hepatectomies: program experience and lessons learned

Introduction:  Living donor hepatectomies are technically challenging and we continue to modify our techniques to decrease morbidities. Patients and methods:  We present our program experience with 114 living donor hepatectomies (95 right lobes, 3 left lobes, 16 left lateral segments) from 3/4/03 to 2/28/06 at the Starzl Transplantation Institute. A total of 208 potential donors were screened, resulting in 114 (54%) living donor hepatectomies and living donor liver transplants (98 adults, 16 pediatric recipients). Results:  In all, 94 potential donors (46%) were declined for the following reasons: fatty livers (43), availability of a deceased donor liver (15), small liver volume (12), workup (6), biopsy consistent with fibrosis (4), polycystic liver disease (3), cardiovascular contraindications (2), mental illnesses (2), hepatitis B (2), and hepatic vascular/biliary anomalies (2). There was no donor mortality and the donor morbidity rate was 8.8%. Three (2.6%) donors had bile leak from cut liver edges with JP removed by 3 weeks (all managed conservatively). Other morbidities included 1 unit pRBC transfusion (2), pneumonia (1), incisional hernia (1), prolonged LFTs (1), deep venous thrombosis (1), and narcotic pscyhosis (1). The mean donor hospital stay was 7 days. Blood loss did not correlate with liver volume but correlated with technique of liver parenchymal dissection. With technique modifications (combination of Tissue Link, Erbe HELIX hydro-jet, endovascuar GIA stapler, and CUSA) during the last 70 right lobe hepatectomies, the mean estimated blood loss has dropped to about 250 mL, with no blood transfusion. Operative time for liver parenchymal dissection has also dropped from about 200 minutes to 90 minutes. Discussion:  With intraoperative technical experience and refinements, previous surgical contraindications are decreasing. A higher percentage of potential living liver donors screened are allowed to donate, with decreasing morbidities.