Elsevier

The Lancet

Volume 362, Issue 9385, 30 August 2003, Pages 687-690
The Lancet

Articles
Operative morbidity of living liver donors in Japan

https://doi.org/10.1016/S0140-6736(03)14230-4Get rights and content

Summary

Background

Deaths of living liver donors have been reported in western countries, whereas the morbidity and mortality of such donors in Japan, one of the leading countries for living liver transplantation, have not been reported in detail. We aimed to review the operative morbidity and mortality of such donors in Japan.

Methods

1853 donors of 1852 living liver transplants done in 46 liver transplant centres, and registered in the database of the Japanese Liver Transplantation Society, were assessed for eight donor-related factors of morbidity and mortality. Data for 1841 donors were analysed.

Findings

No perioperative mortality was recorded since inception of the liver transplantation programme in Japan from Nov 13, 1989, to April 11, 2002. 244 postoperative complications were reported in 228 (12%) donors. The frequency of complications was significantly higher in donors of the right liver lobe than in those involving the lateral segment, and left lobe graft (p<0·0001, and p<0·0001, respectively). Postoperative hospital stay was significantly longer in donors of the right lobe (mean 19·7 [SD 13·0]) than in those of the lateral segment (14·2 [7·6]), left lobe (14·0 [6·5]), and left lobe and caudate lobe (16·3 [12·1]). Re-operation related to donor hepatectomy was done in 23 donors.

Interpretation

By contrast with western countries, no perioperative mortality was recorded in living liver donors in Japan. However, a proportion of these donors developed serious complications. This morbidity should be reduced to maintain zero mortality in living liver donors.

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

References (16)

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