A prospective analysis of living-liver donation shows a high rate of adverse events

Abstract

Donor risk is the main obstacle in the development of living-donor liver transplantation in Western countries. The knowledge of a wide and uneven range of donor morbidity has come mainly from various retrospective analyses of complications in the literature. Donor outcomes have not been prospectively analyzed. From 1995, the intra- and postoperative courses of 127 living-donor hepatectomies were prospectively analyzed and recorded. All adverse events were classified and stratified according to the extent of surgery, including 45 left-lateral sectionectomies (LLS); 25 left hepatectomies (LH), and 57 right hepatectomies (RH). There was no donor death. The overall rate of significant complications was 20%, ranging from 8% after LH to 32% after RH. The overall incidences of surgical complications, reoperations, and hospital readmissions were 8%, 3%, and 5%, respectively. However, the prospective accumulation of all adverse events revealed an overall postoperative morbidity of 51%, ranging from 32% after LH to 66% after RH. In conclusion the incidence of postoperative adverse events after living donation is nearly 50% as revealed by prospective screening. These results allow more accurate information for potential donors. This study confirms that right hepatectomy carries three times higher risk of morbidity as compared to left-sided resections, leading to reappraisal of the use of left grafts in adults.

A 15-Year Review of ABC, CBS, and NBC News Coverage of Organ Donation: Implications for Organ Donation Campaigns

“…Their results revealed that approximately 10% of donors had major respiratory complications following a right hepatectomy. Specifically, some of these patients experienced nonsevere Downloaded by [University of West Florida] at 22:53 04 January 2015 pulmonary embolism, right pleural empyema, and bacterial pneumonia (Dondero et al, 2006). Research needs to continue to follow liver donors and recipients beyond the first year after their procedure to adequately measure success rates.…”

“…This procedure is much riskier than transplanting a living kidney (Bramstedt, 2006). A recent study examined the aversive effects following 112 living-liver donations (Dondero et al, 2006). Their results revealed that approximately 10% of donors had major respiratory complications following a right hepatectomy.…”

Multivariate Analysis of Risk Factors for Pulmonary Complications After Hepatic Resection

“…47 Pulmonary embolism has recently emerged as an increasingly prevalent complication, occurring in perhaps as many as 10% of living-related donors undergoing right hepatectomy. 48 However, less than 50% of patients with pulmonary embolism after hepatectomy have associated deep vein thrombosis. Thrombosis of the hepatic veins is a potential source of pulmonary embolisms.…”

Post-Operative Pharmacologic Thromboprophylaxis after Major Hepatectomy

“…[31][32][33] Interestingly, small studies suggest that a pro-thrombotic state is more common after larger volume compared to small volume liver resections. Among living liver donors, Dondero et al 34,35 note that post-operative PE most often occurred after right hepatectomy compared to after left hepatectomy and left lateral segmentectomy. De Pietri et al 31 observe lower R time and K time on thromboelastogram after major liver resection for malignancy compared to after minor hepatectomy despite higher INR and PTT after major liver resection.…”