Safety of donor right hepatectomy for live donor liver transplantation without abdominal drainage

Abstract

Although the role of routine abdominal drainage after liver resection for tumors has been questioned, abdominal drainage after donor right hepatectomy for live donor liver transplantation (LDLT) has been a routine practice in most transplant centers. Postoperative bile leakage has been reported to occur in 10% to 20% of the donors and abdominal drainage is considered mandatory. The aim of the present study was to evaluate the safety of donor right hepatectomy for LDLT without abdominal drainage. A prospective study was performed on 100 consecutive liver donors who underwent right hepatectomy for LDLT from July 2000 to September 2003. Biliary anatomy was carefully studied with intraoperative cholangiography using fluoroscopy. The middle hepatic vein was included in the graft in all except one patient. Parenchymal transection was performed using an ultrasonic dissector without vascular inflow occlusion. Right hepatic duct was transected at hilum and the stump was closed with 6-O polydioxanone continuous suture. Absence of bile leakage was confirmed with methylene blue solution instilled through the cystic duct stump. Abdomen was closed after careful hemostasis without drainage in all donors. There were 40 male and 60 female donors with a median age of 36 years (range, 18 - 56 years). The median operative blood loss and operating time of the donors was 350ml (range, 42 – 1400 ml) and 448min (range, 310 – 640min), respectively. None of the donors required any blood or blood product transfusion. The median postoperative peak total serum bilirubin level was 59ummol/L, and peak prothrombin time was 17.9 seconds. There was no operative mortality. Median postoperative hospital stay was 8 days (range, 5 – 30 days). Postoperative morbidity occurred in 19 (19%) patients, most of which were minor complications. No donor experienced bile leakage, intraabdominal bleeding or collection. None of them required surgical, radiological, or endoscopic intervention for postoperative complication, except for one donor who developed biliary stricture that required endoscopic dilatation. All donors were well with a median follow-up of 28 months (range, 3 - 42 months). With detailed study of the biliary anatomy and meticulous surgical technique, donor right hepatectomy can be safely performed without abdominal drainage. Abdominal drainage is not a mandatory procedure after donor hepatectomy in LDLT.