Donor Safety and Quality of Life After Left Hepatic Lobe Donation in Living-Donor Liver Transplantation O. Basaran , H. Karakayali, R. Emirog ˘ lu, E. Tezel, G. Moray, and M. Haberal O RTHOTOPIC LIVER transplantation has long been the treatment of choice for patients in the final stages of various types of acute and chronic liver disease. 1 During the past 10 years, the number of individuals on waiting lists for liver transplantation has increased more than 15-fold, aggravating the problem of donor organ shortage. Living- donor liver transplantation (LDLT) is one effective alter- native to decrease this gap. The main concerns related to LDLT outcome are donor morbidity and mortality. Another important issue is the impact of donation on the donor’s quality of life, an increasing focus of interest. Data obtained from health- related quality-of-life surveys, such as the Medical Out- comes Study Short Form-36 (SF = 36), provide physicians with valuable information to assist with clinical decision- making and outcome prediction. 2 The aim of this study was to evaluate the effect of left hepatic lobe surgery to produce complications and to alter the donor’s quality of life. MATERIALS AND METHODS Between December 1988 and October 2001, 69 liver transplanta- tion were performed from cadaveric donors, followed in March 1990 with the first living-donor segmental liver transplantations in pediatric recipients, and in April 1990, adults. Between March 1990 and October 2001, 32 LDLTs in 15 children and 17 adults were performed in our center. Before each operation, the donor candi- date, recipient, and their families were fully informed about left liver lobe donation and partial-liver transplantation. The first phase of the preoperative donor evaluation involved blood type determination, a complete medical history, physical examination by a hepatologist, electrocardiography, chest radiog- raphy, and a screening panel of biochemical laboratory tests. To proceed, the donor candidate’s blood type had to be either identical to or compatible with that of the recipient. Each candi- date who passed the initial phase of testing underwent a second assessment phase with visceral angiography, abdominal tomogra- phy, and liver biopsy. After October 2001, we evaluated the first 15 of the 32 total donors with a medical outcomes study using SF-36. Five of these grafts were received by pediatric patients and the remaining grafts, adult patients. The SF-36 is a short questionnaire comprising 36 items that measure 8 variables: physical functioning (10 items); social functioning (2 items); role limitations due to physical prob- lems (4 items); role limitations due to emotional problems (3 items); mental health (5 items); energy and vitality (4 items); bodily pain (2 items); and energy and general perception of health (5 items). In addition to these items, which are all scored, there is 1 unscaled item that concerns changes in respondents’ health during the year prior to the survey. For each variable, the item scores were coded, summed, and transformed to a number between 0 (worst possible health state measured by the questionnaire) and 100 (best possible health state). 3 We then compared these transformed SF-36 survey scores for the donors with the scores for a control group of 15 randomly selected, healthy, age-matched Bas ¸kent University employees. The values for the donor and control groups were compared using the Student t test. RESULTS The mean postsurgery follow-up period for the 15 donors was 63  7.2 months (range, 8 – 89 months). Nine donors were women and 6 were men with a mean age of the group, 38.4  10.3 years (range, 20 –56 years). Six donors were mothers of the recipients, 5, fathers, 3, siblings, and 1, a cousin. The results of the comparison of the donor and control SF-36 scores are shown in Fig 1. The mean respective scores for donors and controls were as follows: physical function- ing 85 versus 82; physical limitations 88.2 versus 90.6; bodily pain 79.2 versus 81.1; general health 66.4 versus 67.3; vitality 68.3 versus 66.2; social functioning 79.5 versus 78.1; emotional limitations 79.2 versus 81.2; and mental health 67.6 versus 66.1. There were trends toward higher overall donor scores in the areas of physical functioning, vitality, social functioning, and mental health; however, none of the differences between donors and controls were statistically significant (P .05). One of the donors developed a bilioma in the early postoperative period, but there were no serious postoperative complications in the other 14 cases. DISCUSSION For the transplant recipient, LDLT has 3 advantages over conventional transplantation. First waiting time is reduced, meaning that many patients with decompensated liver disease, who would otherwise die waiting for a cadaveric From the Department of Transplantation and General Surgery, Bas ¸ kent University Faculty of Medicine, Ankara, Turkey. Address reprint requests to M. Haberal, Baskent University Faculty of Medicine, 1. Cadde No:77 Bahcelievler, Ankara 06490 Turkey. E-mail: rektorluk@baskent-ank.edu.tr 0041-1345/03/$–see front matter © 2003 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2003.09.088 360 Park Avenue South, New York, NY 10010-1710 2768 Transplantation Proceedings, 35, 2768-2769 (2003)