The incidence of severe complications in liver donation from living donors: Real-world data in the era of minimally invasive surgery

Although living liver donor safety is a fundamental principle in living donor liver transplantation, the details of severe complications that require re-operation or intensive care are not well understood. Therefore, in this study, we summarize those events in liver donation and investigate the difference in complication rates between the open and laparoscopic/robotic approaches in the era of minimally invasive surgery (MIS). We collected the case report forms of donor Clavien-Dindo grade IIIb, IV, and V complications between January 2013 and December 2022 from 16 institutions in the Vanguard Multicenter Study of the International Living Donor Liver Transplantation Group. We then analyzed the difference in complication rates between the open and MIS (laparoscopic/robotic) approaches. A total of 10,025 donor hepatectomies were performed across 16 institutions (8,310 by open or hybrid, 1,479 by laparoscopic, and 236 by robotic). Overall, Clavien-Dindo grade IIIb and IV complications were observed in 1.17% and 0.12%, respectively. There was no mortality in the period. The incidence of grade IIIb and IV complications was comparable between open and MIS cases (1.08% vs. 1.57%, p =0.09, 0.14% vs. 0%, p =0.12). The incidence of postoperative bleeding was more frequent in MIS cases ( p <0.01), especially from the IVC ( p =0.05) and abdominal wall ( p <0.01), compared with those in open cases. The overall incidence of severe complications in liver donation was comparable between the open and MIS approaches. The site of postoperative bleeding differed by surgical approach, suggesting the potential need for different care for MIS to reduce the postoperative complications in donor hepatectomy.