An accepted definition of donor exclusion criteria has not been established for living donor liver transplantation (LDLT). The use of elderly donors to expand the ...
LIVER TRANSPLANTATION 17:548-555, 2011
ORIGINAL ARTICLE
Utilization of Elderly Donors in Living Donor Liver Transplantation: When More is Less? Murat Dayangac, C. Burcin Taner, Onur Yaprak, Tolga Demirbas, Deniz Balci, Cihan Duran, Yildiray Yuzer, and Yaman Tokat Center for Organ Transplantation, Florence Nightingale Hospital, Istanbul, Turkey
An accepted definition of donor exclusion criteria has not been established for living donor liver transplantation (LDLT). The use of elderly donors to expand the living donor pool raises ethical concerns about donor safety. The aims of this study were (1) the comparison of the postoperative outcomes of living liver donors by age (50 versus 28 kg/m2, in those with grade 1 hepatosteatosis according to abdominal ultrasound, and in those who tested positive for hepatitis B core antibody. Potential donors with ultrasound-confirmed grade 2/3 hepatosteatosis were not considered for donation.25,26 All potential donors with a radiological diagnosis of grade 1 steatosis underwent percutaneous liver biopsy. None of these potential donors had more than 15% steatosis. Eligible donors proceeded to the secondary imaging studies, which included a 3-dimensional computed tomography (CT) scan for graft volumetric analysis and the delineation of the vascular anatomy. The liver volume of each donor was calculated by the same radiologist using contrast-enhanced, multidetector CT according to the Cavalieri method.27 The RLV was calculated on the basis of the volumetric study and was expressed as the percentage of the total liver volume. The type of donor right hepatectomy was determined according to both a preoperative CT-based assessment and an intraoperative Doppler ultrasound evaluation. A graft-to-recipient weight ratio (GRWR) of 0.8% was accepted as the safety limit for avoiding small-for-size syndrome in the recipient. The decision to procure the MHV involved a complex and stepwise process that has been described previously.15 A previously established algorithm was used for decision making (Fig. 1). In order to prevent donor morbidity, MHV harvesting was not performed when the median sector of the remnant liver (segment IVb) did not have a separate drainage vein.
Surgical Procedure Donor hepatectomy was performed as previously described.13 An upper midline incision with a right subcostal extension was used for all donors. The central venous pressure was kept at
