Consequences of the Use of Extended Criteria Donors in Living Donor Liver Transplantation

Background: Donor selection criteria are being continuously modified to expand the potential donor pool in living donor liver transplantation (LDLT). This retrospective study reports our center's experience in utilizing extended criteria donors for LDLT. Material/Methods: The charts of 342 LDLT donors who underwent right hepatectomy between September 2007 and December 2010 were reviewed. Donors who were older than 55 years, and/or with BMI >30, and/or with a remnant liver volume of <30% were defined as extended criteria donors. The surgical complications in the extended criteria donors and non-extended criteria donors were compared. Results: There were 61 extended criteria donors (21 male, 40 female; mean age 41 years) and 281 non-extended criteria donors (189 male, 92 female; mean age 31 Years). Surgical morbidities were observed in 70 (20.4%) of donors. The number of patients with complications according to Clavien's system were: Grade I, 30 (43%); Grade II, 11 (16%); Grade IIIa, 12 (17%); Grade IIIb, 16 (23%); and Grade IV, 1 (1%). Postoperative complications were observed in 17 (28%) of 61 extended criteria donors, and 53 (19%) of 281 non-extended donors (p>0.05). However, only the Grade IIIb complication rate in donors with extended criteria was significantly higher than in non-extended criteria donors (p=0.04). Complications developed in 3 of 7 donors aged >55 years and with BMI >30. There was no donor mortality. Conclusions: Although there was no statistical difference between the 2 groups' postoperative complication rates, Grade IIIb complications were statistically significantly higher in the extended group. Having more than 1 extended criteria may increase the donor's postoperative complications in LDLT. Thus, the elimination of the donors should be considered in the presence of more than 1 extended criteria.