Risk Factors for Postoperative Hyperbilirubinemia in Living Donors Undergoing Living Donor Liver Transplantation

Background Post‐hepatectomy liver failure (PHLF) is a major concern in living donor liver transplantation (LDLT). Although predictors of PHLF have been described, large‐scale analyses are limited. Prior evidence linking postoperative peak total bilirubin (TB) with PHLF supports its use as an indirect marker of hepatic dysfunction. Methods This retrospective study included 1003 living liver donors undergoing LDLT. As no donor developed PHLF, postoperative hyperbilirubinemia—defined as peak TB > 7 mg/dL—was used as a surrogate endpoint. Donors were grouped accordingly. Demographic, surgical, volumetric, and laboratory variables were analyzed using univariate and multivariate methods. Thresholds for continuous predictors were examined to identify meaningful cutoffs. Results Postoperative hyperbilirubinemia occurred in 61 donors (6.1%). Higher preoperative TB, male sex, and smaller remnant liver volume independently predicted peak TB > 7 mg/dL. Preoperative TB had the strongest association (OR 14.54), followed by male sex (OR 8.89) and remnant liver volume (OR 1.14). Threshold analysis identified cutoff values of preoperative TB ≥ 1.6 mg/dL and remnant liver volume < 32.7% as potential risk indicators. Conclusions Higher preoperative TB, male sex, and smaller remnant liver volume predict postoperative hyperbilirubinemia in living donors. Although PHLF did not occur, peak TB may reflect hepatic dysfunction and aid donor risk stratification.