Living Donor Hepatectomy: Is it Safe?

Abstract

Living donor hepatectomy (LDH) is high risk to a healthy donor and remains controversial. Living donor nephrectomy (LDN), conversely, is a common practice. The objective is to examine the outcomes of LDH and compare this risk profile to LDN. The Nationwide Inpatient Sample was queried for hepatectomies and nephrectomies from 1998 to 2011. LDH or LDN were identified by donor ICD-9 codes. Outcomes included in-hospital mortality and complications. Bivariate analysis compared nondonor hepatectomy or nondonor nephrectomy (NDN). Multivariate analyses adjusted for baseline organ disease, malignancy, or benign lesions. There were 430 LDH and 9211 nondonor hepatectomy. In-hospital mortality was 0 and 6 per cent, respectively (P < 0.001); complications 4 and 33 per cent (P < 0.001). LDH had fewer complications [odds ratio (OR) 0.15 (0.08-0.26)]. There were 15,631 LDN and 117,966 NDN. Mortality rates were 0.8 per cent LDN and 1.8 per cent NDN (P < 0.001). Complications were 1 and 21 per cent (P < 0.001). LDN had fewer complications [OR 0.06 (0.05-0.08)] and better survival [OR 0.32 (0.18-0.58)]. Complication rates were higher in LDH than LDN (4% vs 1%, P < 0.001), but survival was similar (0% vs 0.8% mortality, P = 0.06). In conclusion, morbidity and mortality rates of LDH are significantly lower than hepatectomy for other disease. This study suggests that the risk profile of LDH is comparable with the widely accepted LDN.