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Letters to the Editor

Reply to “Reducing the Safety Limit for Remnant Liver Volume in Living Donor Hepatectomy: Are We Pushing the Envelope Off the Edge?”

Gorgen, Andre MD1,2; Sapisochin, Gonzalo MD, PhD1,2

Author Information
doi: 10.1097/TP.0000000000003690
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Thank you, Drs M. Srinivas and M. Rela, for your insightful comments on our publication “Outcomes of Highly Selected Live Donors With a Future Liver Remnant Less Than or Equal to 30%: A Matched-Cohort Study.”1

We agree with Drs Srinivas and Rela when they say that donor safety must be the cornerstone of live donation. In fact, our practice with regard to donor selection and their outcomes in our center is previously published demonstrating safety.2,3 In this study, we state that donors with remnant <30% should be considered only in very selected cases. Therefore, we also agree with the authors in that regard.

The main message in this study is that a solid number of 30% could be safely relaxed in selected cases after (1) thorough evaluation by experienced live donation surgeons and (2) the referred donor is the only donor available for a specific recipient. In our study, therefore, rather than pushing to the edge, we push the envelope against dogmatic and arbitrary thresholds—so common in the surgical field—that could prevent saving a recipient life and keeping the donor safe.

Again, thank you for your letter.


1. Zuckerman J, Gorgen A, Acuna SA, et al. Outcomes of highly selected live donors with a future liver remnant less than or equal to 30%: a matched-cohort study. Transplantation. [Epub ahead of print. November 24, 2020]. doi:10.1097/TP.0000000000003559
2. Gorgen A, Goldaracena N, Zhang W, et al. Surgical complications after right hepatectomy for live liver donation: largest single-center Western world experience. Semin Liver Dis. 2018;38:134–144.
3. Sapisochin G, Goldaracena N, Laurence JM, et al. Right lobe living-donor hepatectomy-the Toronto approach, tips and tricks. Hepatobiliary Surg Nutr. 2016;5:118–126.
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