*Purpose: Recently, some centers reported that extended resection with remnant/total volume ratio(RTVR) less than 30% for living donor right hepatectomy(LDRH) but there is no consensus which has been established for safe remnant/total volume ratio (RTVR) limit. Moreover, most centers keep this strict criteria for donor safety. Herein, we describe out center’s experience for LDRH with RTVR < 30% and evaluate the postoperative outcomes for living donors with RTVR < 30%.

*Methods: We retrospectively reviewed the outcomes of 473 LDRHs which performed at our institution from January 2010 to December 2020. We performed right hepatectomy for living donors with RTVR < 30% under the following criteria ; 1) Age ≤ 40 2) Preservation of middle hepatic vein 3) No or Minimal fatty changes (<15%) 4) Flat fish shaped left hemiliver 5) RTVR > 25% and remnant liver volume / body weight ≥ 0.45. The outcomes in these extended criteria for living donors were compared with those in living donors under conventional criteria.

*Results: Posthepatectomy liver failure(PHLF) occurred in 50 donors (10.6%) and most cases were grade A except one case and no clinically significant PHLF was not evident in these extended donor criteria group. PHLF and major complications were not more frequent in living donor group with RTVR <30%. In multivariate analysis, the only event for major complications was associated with PHLF but RTVR < 30% was not related to PHLF. Moreover, in subgroup analysis with donor group in RTVR ≥ 30% with same age and steatosis criteria, the evidences for PHLF and major complications were not different between the two groups.

*Conclusions: LDRH under our extended criteria could be performed safely in donors with RTVR ratio <30% under our strict criteria when no other living donors are available.

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