Pulmonary Complications After 1150 Living Donor Hepatectomies M. Ates, E. Kinaci, A. Dirican*, B. Sarici, V. Soyer, S. Koc, and S. Yilmaz Department of General Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey ABSTRACT Aim. Donor safety is the major concern in living-donor liver transplantation. Studies in literature related to donor hepatectomy (DH) have generally considered intra-abdominal complications. The aim of this study is to specifically evaluate pulmonary complications (PCs) after DH. Materials and Methods. We evaluated retrospectively 1150 living donors who underwent to DH between January 2007 and July 2014. Patients with PCs, such as pneumonia, pleural effusion, pneumothorax, and respiratory insufficiency, were considered. A complication was considered only when it was clinically apparent and/or requiring interventions. Any special diagnostic tool was used to expose the clinically silent pathologies. Results. A total of 986 right hepatectomies (RH) and 164 left hepatectomies (LH) (left lobectomy or left lateral segmentectomy) were performed in the study interval. There were 18 (1.6%) donors with PCs (15 males and 3 females). Mean age was 33.8 Æ 9.3 years (18e51). Mean hospital stay was 23.8 Æ 13.5 days (5e62). Presented PCs were pleural effusion (n ¼ 5, 0.4%), pneumonia (n ¼ 4, 0.3%), combinations (n ¼ 2, 0.2%), pneumothorax (n ¼ 2, 0.2%), and acute respiratory insufficiency (n ¼ 5, 0.4%). Sixteen cases (1.7%) were seen after RH, whereas 2 cases (1.2%) were seen after LH (P ¼ 1.000). Conclusion. The most common PCs after living donor hepatectomy were pleural effusion and acute respiratory insufficiency. There was no significant difference between RH and LH. It is possible to overcome those PCs with careful monitoring and timely and appropriate treatment. L IVING donor liver transplantation is a widely accepted treatment option for end-stage liver disease. However, transplant surgeons are faced with another challenge: donor safety. Reports of donor deaths [1] have increased transplant surgeons’ concerns regarding donor safety. Almost all high- volume centers have reported their complication rates after donor hepatectomy. Although they vary according to the type of graft (right lobe, left lobe, or left lateral sector), reported complication rates are between 7.6% and 46.4% [2e6]. We have previously reported our 30% complication rate [7]. Complications related to the pulmonary system had not been specifically considered in literature. To the best of our knowledge, only 1 study specifically reported the respiratory complications of 112 living liver donors [8]. Here, we aim to specifically consider the headlines of pulmonary complications (PCs) after living-donor hepatectomy. MATERIALS AND METHODS We retrospectively evaluated the records of 1150 living donors who underwent donor hepatectomy between January 2007 and July 2014. Donor selection and surgical procedure have been described in detail elsewhere [7,9]. After surgery, all donors were extubated before leaving the operating room and were admitted to the intensive care unit at least overnight for monitoring. Nasogastric tube and Foley catheter were removed and oral intake was started on the first postoperative day. To prevent thromboembolic events, surgical stockings and compression sleeves associated with early mobilization postoperatively were used during surgery. Low-molecular-weight heparin was not routinely used. Respiratory exercises have it made to all donors postoperatively. In postoperative management, chest pain, fever, dyspnea, sputum expectoration, and decrease in oxygen saturation were considered as signs of respiratory complications. We took daily chest radiographs in the postoperative period and, when necessary, thoracic computed tomography was undertaken. In patients with fever and sputum expectoration, blood and sputum samples were obtained for micro- biological analysis and culture antibiogram. *Address correspondence to Abuzer Dirican, MD, Turgut Ozal Medical Center, Department of General Surgery, Malatya, Turkey. E-mail: abuzerdirican@gmail.com ª 2015 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 0041-1345/15 http://dx.doi.org/10.1016/j.transproceed.2015.04.038 Transplantation Proceedings, 47, 1319e1322 (2015) 1319