Recent advancements in and views on the donor operation in living donor liver transplantation: a single-center study of 886 patients over 13 years.

Donor safety remains an important concern in living donor liver transplantation (LDLT). In the present study, we assessed recent advancements in the donor operation for LDLT through our experience with this procedure. A total of 886 donor hepatectomies performed between January 1999 and December 2012 were analyzed. Three chronological periods were investigated: the initial period (1999-2004, n = 239), the period in which the right liver with middle hepatic vein reconstruction was primarily used (2005-2010, n = 422), and the period in which the right liver with a standardized protocol, including a preoperative donor diet program, an evaluation of steatosis with magnetic resonance spectroscopy, no systemic heparin administration or central venous pressure monitoring, exact midplane dissection, and incremental application of minimal incisions, was exclusively used (2011-2012, n = 225). The proportion of patients > 50 years old increased (2.5% versus 4.7% versus 8.9%), whereas the proportion of patients with a remnant liver volume ≤ 30% (6.5% versus 13.9% versus 6.3%) and with macrosteatosis ≥ 10% (7.9% versus 11.1% versus 4.4%) decreased throughout the periods. The operative time (292.7 versus 290.0 versus 272.8 minutes), hospital stay (12.4 versus 11.2 versus 8.5 days), and overall morbidity rate (26.4% versus 13.3% versus 5.8%), including major complications (>grade 3; 1.7% versus 1.9% versus 0.9%) and biliary complications (7.9% versus 5.0% versus 0.9%), were markedly reduced in the most recent period. No intraoperative transfusion was required. No cases of irreversible disability or mortality were noted. In conclusion, the quality of the donor operation has recently been standardized through a large volume of experience, and the operation has been proven to have minimal risk. However, a constant evaluation of our experience is critical for remaining prepared for any unavoidable crisis.