We thank Dr. Takatsuki and colleagues for their comments on our article. 1 In the cases described in our work, the recipient died when the operation in the donor had already progressed beyond the division of the hepatic duct. As a consequence of the resulting "hepar divisum" we found that biliary complications are almost the norm and main point of our article was to share our experience with the surgical management of the "hepar divisum" in the donor.
The timing of the hepatic duct division is a totally separate but still much debated issue. [2][3][4] Our center and others have adopted early hepatic division for the same reasons that made Dr. Takatsuki opt for division after parenchymal transection: it is easy, and it preserves hilar plate tissues and blood supply. Moreover, the claim of bile contamination is totally unfounded and certainly does not reflect our extensive experience with more than 200 cases. 1,4,5 Also, in our center the donor and the recipient surgeries run parallel and constant communication between the two surgical teams is in place.
Therefore, it remains our preference to divide the hepatic duct prior to the transection of the liver parenchyma and we do not think that hepatic duct division after parenchymal transection should be adopted as standard procedure for right living donor hepatectomy based only on the unfortunate events described in our article.