Results of 132 Hepatectomies for Living Donor Liver Transplantation: Report of One Death J.C. Wiederkehr, J.C. Pereira, M. Ekermann, F. Porto, W. Kondo, I. Nagima, W. Amaral, C.A. Camargo, and M. Moreira ABSTRACT Aims. Liver transplant is the primary therapy for patients with end-stage liver disease. Its high success rates have lead to a broadening of the indications for liver transplantation, resulting in an increasing shortage of donors. Living donor liver transplantation has become an option to overcome waiting list mortality. We describe our experience with hepatectomy for living donor liver transplantation and report a case of death. Methods. Patients (n = 132) underwent hepatectomy for living donor liver transplan- tation from June 2000 through June 2004. A 4-phase preoperative evaluation was performed on all patients, whose ages ranged from 13 to 54 years (mean = 29.7  8.1 years). Of the 132 patients, 76 patients (57.5%) underwent left lateral segmentectomy, 33 patients (25%) underwent left lobectomy, and 23 patients (16%) underwent right hepatectomy. In 2 other patients (1.5%), a monosegment (segment II) was obtained after left lateral segmentectomy. Results. Twenty patients (15%) experienced a complication, the most common being incisional hernia, pneumonia, and biliary fistulae. On the seventh postoperative day, 1 patient developed a fatal cerebral hemorrhage while recovering from mild liver dysfunction. Conclusions. Although living donor liver transplantation is generally safe, serious and fatal complications may occur. L IVER TRANSPLANTATION is the primary therapy for patients with end-stage liver disease. The high success rates have broadened the indications for the proce- dure, resulting in a shortage of cadaveric donors. Conse- quently, longer waiting times and increasing numbers of deaths in patients awaiting an organ have become serious problems for candidates. To overcome the waiting list mortality, living donor liver transplantation (LDLT) has become an option. After the first successful living donor liver transplantation reported in 1990, 1 this surgical inno- vation has evolved to established efficacy in the literature. Donor safety is the single most important clinical issue related to LDLT. Although morbidity and mortality are always major concerns, they are especially so in a previously healthy person who does not need an operation. We describe our experience with hepatectomy for LDLT, reporting a death. PATIENTS AND METHODS The charts of patients submitted to partial hepatectomy for LDLT were reviewed retrospectively. From June 2000 through June 2004, we performed 132 LDLTs for pediatric and adult recipients. The donor age ranged from 13 to 54 years (mean = 29.7  8.1 years) using 68 (51.6%) men and 64 (48.4%) women. The majority of donors (114, 86.3%) were related up to the fourth degree (cousins or uncle); 11 donors (8.3%) were spouses and 7 donors (5.4%) were unrelated. The donor evaluation protocol consisted of 4 phases; for each phase informed consent was obtained. Computed tomography or ultrasound examinations were used to estimate graft volume. For the arterial anatomy evaluation, angiography was done in all patients. Cholangiogram was performed intraoperatively in all patients. For the parenchyma dissection, a Saphyr Handy jet dissector was used along with Ultracision harmonic cautery. An From the Santa Casa de Curitiba and Hospital Pequeno Principe, Catholic University of Parana PUCPR, Parana, Brazil. Address reprint requests to Julio Cesar Wiederkehr, MD, Santa Casa de Curitiba, Catholic University of Parana PUCPR, Division of Liver Transplantation, Alameda das Buganvilias 754, Curitiba, Parana 81210-190, Brazil. E-mail: wiederke@ uol.com.br © 2005 by Elsevier Inc. All rights reserved. 0041-1345/05/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2004.12.221 Transplantation Proceedings, 37, 1079 –1080 (2005) 1079