Hepatic grafts from live donors: donor morbidity for 470 cases of live donation

Living donor-morbidity was evaluated in 470 consecutive cases of living don or liver transplantation carried out from June 1990 to May 1999 at Kyoto Un iversity. Grafting was categorized into 4 groups according to the resection lines; left lateral segmentectomy (S2 + 3, n = 282, R1), extended left lat eral segmentectomy without middle hepatic vein (MHV) (S2 + 3 + part4, n = 4 5, R2), left lobectomy with MHV (S2 + 3 + 4, n = 99, R3) and right lobectom y without MHV (S5 + 6 + 7 + 8, n = 43, R4). Intraoperative blood loss and o peration duration were less for left lateral segmentectomy, but no signific ant difference was observed between left lobectomy and right lobectomy. The length of postoperative hospital stays was comparable among all groups exc ept for the group with right lobe grafting. The AST values at the peak and at POD 7 were significantly elevated for right lobectomy, but the AST value normalized within one month in the majority of the cases. The close follow -up of donors with more than 1000 mi intraoperative bleeding, and of those donors who stayed in hospital for more than 30 days, the close followup, fu rthermore, of those donors with AST values higher than 100 IU/L AST after o ne month, revealed complete recovery. Biliary leakage was the most common a nd annoying complication after donor operations, especially in for right lo be grafting, but all donors recovered completely with conservative or minim al invasive therapy. The two cases of re-operation due to adhesive mechanic al ileus we encountered were resolved completely. Finally, no donor-operati on related death was noted. In conclusion, the morbidity of living donors i s low or minimal even for right lobectomy, the most extended procedure, and complete recovery can be expected in all cases.