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Liver Transpl. 2017 Feb;23(2):184-193. doi: 10.1002/lt.24651. Epub 2016 Dec 30.

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

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Transplant Center, Division of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Department of Experimental Medicine, University of Pavia, Pavia, Italy.
Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione-University of Pittsburgh Medical Center, Palermo, Italy.
Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Italy.
Liver Transplant Unit, Department of Medical and Biological Sciences, University Hospital, Udine, Italy.
Hepato-Pancreato-Biliary Surgery and Liver Transplant Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.
Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Maggiore Hospital, Milan, Italy.
Abdominal Organ Transplant Center, Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, Bologna, Italy.
Department of Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
School of Medicine, University of Milano-Bicocca, Milan, Italy.


Major concerns about donor morbidity and mortality still limit the use of living donor liver transplantation (LDLT) to overcome the organ shortage. The present study assessed donor safety in LDLT in Italy reporting donor postoperative outcomes in 246 living donation procedures performed by 7 transplant centers. Outcomes were evaluated over 2 time periods using the validated Clavien 5-tier grading system, and several clinical variables were analyzed to determine the risk factors for donor morbidity. Different grafts were obtained from the 246 donor procedures (220 right lobe, 10 left lobe, and 16 left lateral segments). The median follow-up after donation was 112 months. There was no donor mortality. One or more complications occurred in 82 (33.3%) donors, and 3 of them had intraoperative complications (1.2%). Regardless of graft type, the rate of major complications (grade ≥ 3) was 12.6% (31/246). The overall donor morbidity and the rate of major complications did not differ significantly over time: 26 (10.6%) donors required hospital readmission throughout the follow-up period, whereas 5 (2.0%) donors required reoperation. Prolonged operative time (>400 minutes), intraoperative hypotension (systolic < 100 mm Hg), vascular abnormalities, and intraoperative blood loss (>300 mL) were multivariate risk factors for postoperative donor complications. In 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. Liver Transplantation 23 184-193 2017 AASLD.

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