The incidence of severe complications in liver donation from living donors: Real-world data in the era of minimally invasive surgery

초록

Background: Although the living liver donor safety is a fundamental principle in living-donor liver transplantation (LDLT), the details of severe complications that require re-operation or intensive care is not well understood. Therefore, in this study, we summarize those events in liver donation and investigate the difference in complication rate between open and laparoscopic/robotic approach in the era of minimally invasive surgery (MIS). Methods: We collected the case report forms of donor Clavien-Dindo grade IIIb, IV, and V complications between January 2013 to December 2022 from 16 institutions in the Vanguard Multicenter Study of the International Living Donor Liver Transplantation Group. We then analyzed the difference in complication rate between open and MIS (laparoscopic/robotic) approach. Results: 10,025 donor hepatectomy was performed across 16 institutions (8,310 by open or hybrid, 1,479 by laparoscopic, 236 by robotic). Overall Clavien-Dindo grade IIIb and IV complication was observed in 1.17 and 0.12%, respectively. There was no mortality in the period. The incidence of grade IIIb and IV complication was comparable between open and MIS cases (1.08% vs. 1.57%, p=0.09, 0.14% vs. 0%, p=0.12). The incidence of postoperative bleeding was more frequent in MIS cases (p<0.01), especially from inferior vena cava (p=0.05) and abdominal wall (p<0.01) compared with those in open cases. Conclusions: Overall incidence of severe complications in liver donation was comparable between open and MIS approach. The site of postoperative bleeding differed by surgical approach, suggesting potentially need of different care for MIS to reduce the postoperative complication in donor hepatectomy. © 2025 American Association for the Study of Liver Diseases.

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