Less than 35% of residual liver volume, is it safe for young donor in living donor liver transplantation? Comparative study

Background
Most of the studies showed that the residual liver volume (the remaining liver tissue after partial hepatectomy) in living donor liver transplantation (LDLT) should be more than 35%, as it carries the best outcome for the donor after transplantation and the least incidence of complications. In this study, we compared the outcome of LDLT in case of residual volume between 30 and 34.9% versus residual liver volume above 35%, to increase the donor pool without affecting the safety of the donor.
Objective
To compare the outcome of LDLT with donors having residual liver volume between 30 and 34.9% versus residual liver volume above 35% regarding postoperative liver function tests (aspartate aminotransferase, alanine aminotransferase, bilirubin, and international normalized ratio), hospitals stay, and other postoperative complications.
Patients and methods
Type of study: a cohort retrospective study was conducted. Study setting: The study was conducted at Ain Shams University Hospital and Cairo Fatemic Hospital. Study population: A total of 40 donors were divided into two groups. Group A included 20 donors with residual liver volume 30–34.9%, and group B included 20 donors with residual liver volume more than 35%. Inclusion criteria were age between 18 and 35 years, BMI between 18 and 30, no hyperlipidemia, and on liver biopsy, steatosis was less than 10%. Exclusion criteria were age less than 18 or above 35 years, BMI was below 18 or above 30, presence of hyperlipidemia, and on liver biopsy, steatosis more than 10%.
Results
There was a nonsignificant difference between the groups in our study regarding grading of complications (I–V) according to modified Clavien system. There was a nonsignificant statistical difference between both groups in this study regarding peak aspartate aminotransferase, peak alanine aminotransferase, and peak international normalized ratio (=0.494, 0.482, and 0.278, respectively). Peak total bilirubin, peak direct bilirubin, and peak creatinine were significantly higher among cases of group A (remnant liver volume 30–34.9%) in the current study. Mean peak total bilirubin, peak direct bilirubin, and peak creatinine were 4.82±3.01, 2.67±2.14, and 0.82±0.16, respectively, versus 2.83±1.60, 1.41±1.58, and 0.77±0.16, respectively, in control group (=0.013, 0.041, and 0.032, respectively). There was a nonsignificant difference between both groups in our study regarding hospital stay.
Conclusion
Overall, 30–34.9% of residual liver volume in selected donors was as safe as above 35% of residual liver volume.