Postoperative Donor Liver Damage Can Predict Recipient Short-Term Survival in Living Donor Liver Transplantation

Background. In living donor liver transplantation, surgical damage is a risk for graft dysfunc-tion. We hypothesized that postoperative donor laboratory data reflect both donor liver damage and graft damage. Therefore, we evaluated how donor surgical factors affected recipient graft function and prognosis.& nbsp;Patients and Methods. From March 2002 to December 2020, 130 consecutive recipients and donors who underwent adult-to-adult living donor liver transplantation were analyzed. Donor perioperative surgical factors were evaluated to assess risk factors for recipient 90-day mortality by univariate analysis.& nbsp;Results. Donor postoperative maximum levels of aspartate aminotransferase (AST; P = .016), alanine transaminase (P = .048), and prothrombin time-international normalized ratio (P = .034) were risk factors. Receiver operating characteristic analysis identified 214 U/L as the most appro-priate cutoff value of donor postoperative AST.& nbsp;After excluding 22 pairs of patients without donor data, the 108 pairs were divided into 2 groups based on donor maximum AST (D-mAST) level: the low D-mAST group (D-mAST < 241 U/L, n = 39) and the high D-mAST group (D-mAST & GE; 241 U/L, n = 69). Donor age was significantly higher in recipients in the high D-mAST group than in the low D-mAST group (P = .033). Post-operative recipient maximum AST and alanine transaminase levels and 90-day mortality were significantly higher in the high D-mAST group than in the low D-mAST group (P = .001, P = .006, and P = .009, respectively). There were no significant differences in long-term survival, although 5-year survival was slightly lower in the high D-mAST group.& nbsp;Conclusions. Surgical liver damage to grafts, as assessed by postoperative donor AST levels, affected recipient short-term survival.