Donor Safety and Risk Factors of Pure Laparoscopic Living Donor Right Hepatectomy: A Korean Multicenter Study

Objective: The aim of this study was to identify safety and risk factors of living donor after pure laparoscopic donor right hepatectomy in a Korean multicenter cohort study. Background: Pure laparoscopic donor right hepatectomy is not yet a standardized surgical procedure due to lack of data. Methods: This retrospective study included 543 patients undergoing PLRDH between 2010 and 2018 in 5 Korean transplantation centers. Complication rates were assessed and multivariate logistic regression analyses were performed to identify risk factors of open conversion, overall complications, major complications, and biliary complications. Results: Regarding open conversion, the incidence was 1.7% and the risk factor was body mass index >30 kg/m(2) [P=0.001, odds ratio (OR)=22.72, 95% CI=3.56-146.39]. Rates of overall, major (Clavien-Dindo classification III-IV), and biliary complications were 9.2%, 4.4%, and 3.5%, respectively. For overall complications, risk factors were graft weight >700 g (P=0.007, OR=2.66, 95% CI=1.31-5.41), estimated blood loss (P<0.001, OR=4.84, 95% CI=2.50-9.38), and operation time >400 minutes (P=0.01, OR=2.46, 95% CI=1.25-4.88). For major complications, risk factors were graft weight >700 g (P=0.002, OR=4.01, 95% CI=1.67-9.62) and operation time >400 minutes (P=0.003, OR=3.84, 95% CI=1.60-9.21). For biliary complications, risk factors were graft weight >700 g (P=0.01, OR=4.34, 95% CI=1.40-13.45) and operation time >400 minutes (P=0.01, OR=4.16, 95% CI=1.34-12.88). Conclusion: Careful donor selection for PLRDH considering body mass index, graft weight, estimated blood loss, and operation time combined with skilled procedure can improve donor safety.