Introduction: Donor safety has been the primary focus of transplant programs that perform living donor liver transplantation (LDLT) and major living donor complications could be avoidable under the strict selection criteria of living donors. Recently, strict donor selection criteria has been modified to expand the donor pool in LDLT but the concept for extended donor is not clearly defined yet. Herein, we describe out center’s experience for extended criteria donors in LDLT focusing on donor safety.
Materials and Methods: We retrospectively reviewed the outcomes of 424 living donor right hepatectomy (LDRH) including 105 extended criteria donors who performed at our institution from January 2010 to June 2019. Extended Donor criteria was defined as follows; 1) old donor (age >40 years) with remnant liver volume of <35%, 2) young donor (age ≤40 years) with remnant liver volume <29% and minimal fatty change (<15%), 3) young donor with mild hepatosteatosis (15%-30%) and remnant liver volume of < 35%. The outcomes in extended living donors were compared with those in living donors using conventional criteria focusing on donor safety. Posthepatectomy liver failure (PHLF) was defined according to the International Study Group of Liver Surgery (ISGLS) criteria. We also included statistical analysis of risk factors that are related to PHLF.
Results: PHLF occurred in 43 donors (10.1%) and most cases were grade A except one case in conventional donor group (grade B) and PHLF did not occur more frequently in extended donor group. (7.6% vs. 11.0% % P = 0.32) and the incidence of major complications requiring radiological or surgical interventions did not differ between the 2 groups. Moreover, no difference in either posttransplant graft function or survival was apparent between the 2 groups. In multivariate logistic regression analyses, only major complication (OR, 3.002; 95% CI, 1.042-8,649; P = 0.04) was associated with PHLF but not related to our extended donor criteria.
Conclusion: LDRH under our extended criteria could be performed to expand donor pools without adverse effects on donor safety.