Living Liver Donor Selection and Resection at the University of Tokyo Hospital

• Donor safety is the highest priority not only for donors themselves but also for LDLT program, and the maximal effort should be applied in donor selection and operation for donor safety.
• In reporting donor complications, near-miss events and aborted hepatectomies should also be reported.
• Left liver graft can be utilized with an appropriate preoperative evaluation in adult-to-adult LDLT without impairing recipient outcome, which may be preferable in terms of donor safety.

ObjectivesDonor selection and operative procedures for adult-to-adult living donor liver transplantation at the University of Tokyo are presented.MethodsDonor selection criteria are as follows: age between 20 and 65 years, within 3 degrees of consanguinity, without coercion, free from any major comorbidities, body mass index (BMI) < 30, and ABO blood type identical or compatible. Liver biopsy is indicated for BMI > 25 kg/m2 or any liver function abnormality, and those with macroscopic steatosis >10% are rejected. Thereafter, an indocyanine green retention test and dynamic computed tomography are evaluated. Graft type is determined based on computed tomography volumetry. An estimated graft volume of 40% to recipient standard liver volume ratio is the lower limit. For donor safety, the left liver is the first choice, provided that it satisfies the lower limit. Otherwise, right liver harvesting is indicated, providing that the estimated remnant liver volume is >30% of the donor's total liver volume. A posterior sector graft is a possible option.ResultsBetween 1996 and 2014, 462 donor hepatectomies were performed, with 257 right livers, 179 left livers, and 26 posterior sectors. There was no mortality, and the incidence of morbidity grades I, II, IIIa, and IIIb was 16%, 5%, 5%, and 3%, respectively, without a difference between right and left liver grafts. The left liver was used without impairing recipient outcome. Two aborted hepatectomies (0.4%) and 3 near-miss events (0.6%) were encountered.ConclusionsMaximal effort should be applied to donor selection and operation for donor safety.