EVOLUTION OF DONOR MORBIDITY IN LIVING RELATED LIVER TRANSPLANTATION– SINGLE CENTER ANALYSIS OF 165 CASES -

Abstract

O297 Background/Purpose: During the last 14 years living donor liver transplantation (LDLT) has evolved to an indispensable surgical strategy to minimize mortality of adult and pediatric patients awaiting transplantation. The crucial prerequisite to perform this procedure is a minimal morbidity and mortality of the healthy living donor. Little is known about the learning curve involved with this type of surgery. Patients and Methods: From January 1991 to August 2003 a total of 165 LDLT were performed in our center. Out of these there were 135 donations of the left-lateral lobe (LL, segments II, III), 3 of the left lobe (L, segments II-IV), 3 full-left lobes (FL, segments I to IV) and 24 of the full-right lobe (FR, liver segments V-VIII). We divided the procedures in 3 periods: Period 1 comprised the years 1991 to 1995 (LL: n=49, L: n=2, FR: n=1), period 2 the years 1996-2000 (LL: n=47) and period 3 the years 2001 to August 2003 (LL: n=39, FR: n=23, FL: n=3, L: n=1). Perioperative mortality and morbidity were assessed using a standardized classification. Length of stay on ICU, postoperative hospital stay, laboratory results (bilirubin, INR and LFT‘s) and morbidity, were compared between the three different periods of time as well as between the different types of grafts. Results: One early donor death was observed in period 1 (03/07/93, case 30) (total mortality: 0,61.%). Since 1991 the perioperative morbidity has declined continually (53,8 % vs. 23,4 % vs. 9,2 %). In period one 28 patients had 40 complications. In period two 11 patients had 12 and in period three 6 patients had 9 complications. Within the first period one donor underwent relaparotomy because of bile leakage. Postoperative hospital stay was 10 d, 7 d, and 6 d, respectively. Donation of the full right lobe, in comparison to that of the left lateral lobe, resulted in a significantly diminished liver function (bilirubin and INR) during the first three days after donation but did not increase morbidity. One donor from period 1 experienced late death due to amyotrophic lateral sclerosis. Conclusions: In a single center, morbidity after living liver donation strongly correlates to centre experience. Despite the additional risks attached to temporary reduction of liver function, this experience allows to avoid part of the learning curve when starting right lobe donation. Specific training of the surgical team and coaching by an experienced centre should be implemented for newly starting centers to avoid the learning curve.