Is right hepatectomy for liver living donation really comparable to right hepatectomy for benign liver lesions?

Introduction: Right hepatectomy (RH) for adult to adult living liver donation (LD) remains risky despite major progress in the last 10 years. In order to elucidate factors explaining this lower tolerance of a standardized procedure we prospectively studied the outcome of patients (pts) who underwent a RH for benign lesions (BL) in comparison with RH for LD. Materials and methods: From 2001 we studied prospectively the pre- and post-operative data, including volumetric variations of 26 RH for BL. This group was matched with 26 LD which underwent a RH in the same period. The two groups (BL vs LD) were similar for age (43±11 vs 46±11 years), sex and BMI (25±4 vs 23±3). All pts have the same pre- and post-operative assessment (preoperative CT scan with volumetric measurements and study of coagulation profi le, biological tests every day until POD 7, including an abdominal CT scan on POD 7). Results: The comparison of the two groups (BL vs LD) showed that operation duration was longer in LD group (320±76 vs 382±65 min) (p=0.004). The blood loss was similar (623±260 vs 590±350 mL). Postoperative biochemical data showed that total serum bilirubin was signifi cantly higher in LD group in POD 2, 3, 5 and 8. Morbidity classifi ed with the Clavien’s system was similar in both groups 38% vs 42% p=ns. The mortality was nil. After subtraction of the tumor’s volume (mean 421±530 cc) in the BL group the total liver volume was similar in both groups (1438±226 vs 1460 ± 318 cc) but the left remnant liver volume was higher in the BL group (650±216 vs 455±152 cc) (p<0.001) representing 35±7% in BL group vs 31±7% in LD group (p=0.03). The ratio remnant weight/body weight was higher in BL pts (1±0.32 vs 0.7±0.23) (p<0.001). At POD 7 the left remnant liver was similar in the two groups (947 vs 862 cc) demonstrating a regeneration rate of 57% in BL group as compared to 84% in LD group (p=0.009). Conclusions: This study demonstrates that RH for LD is not comparable to the same procedure in pts with BL. The left liver which is smaller in LD group acquires the same volume at day 7 refl ecting a higher process of regeneration. These results showing that in LD an important deprivation of liver volume restored by a signifi cant and sudden regeneration in the fi rst postoperative week may be the background promoting fatal complications.