ArticlesOperative morbidity of living liver donors in Japan
Introduction
The first case of living donor liver transplantation (LDLT) was done in Brazil, in December, 1988,1 and the first successful case was reported in Australia.2 In Japan, LDLT was started in November, 1989, and the first successful operation done in an adult was in 1994.3 The number of LDLTs every year has increased progressively, reaching 417 in 2001. According to the registry of the Japanese Liver Transplantation Society,4 as many as 1789 LDLTs had been done by the end of December, 2001, and the procedure is at present accepted by members of the society as the best treatment for end-stage liver disease.
An important limitation of LDLT, however, is the safety of the donor. Investigators have reported deaths in living liver donors in the USA.5 However, we do not know of any national surveys of morbidity and mortality of such donors in Japan. The ethics committee of the Japanese Liver Transplantation Society indicated the necessity of such a survey. Thus, have we reviewed the operative mortality and morbidity of living liver donors in Japan.
Section snippets
Methods
By April 11, 2002, 1852 LDLTs were registered in the database of the Japanese Liver Transplantation Society. A questionnaire about the operative mortality and morbidity of such donors was sent to the 46 liver transplant centres where the operations had been done. We obtained data anonymously so as not to invade donor privacy and did not ask for consent for that reason. Approval for this study was granted by the society's ethics committee. Eight donor-related factors (sex, age, relation to the
Role of the funding source
The sponsors of the study had no involvement in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the manuscript for publication.
Results
Answers to the questionnaire were obtained for all 1853 living liver donors (one recipient was given dual liver grafts; right lobe graft from one donor and left lobe graft from another). 12 donors were excluded from analysis since they were secondary donors of domino liver transplantation, leaving 1841 for further analysis, of which 943 were men and 898 women. Mean donor age was 37 years (SD 10) (median 35 years, range 17-69 years). A parent was the most common donor, followed by child,
Discussion
The mortality rate in living liver donors has been reported to be 1% or less by the European Liver Transplant Registry,6, 7 and a donor mortality rate as low as 0·3% was reported in the USA.8, 9 As many as seven cases of donor deaths were recently reported in the USA by Surman,5 which surprised liver transplant surgeons worldwide, although the number was wrong and subsequently corrected to three by the researcher himself.10 Two donors of the right hepatic lobe were reported to have had to
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