Aborted donor hepatectomy in living donor liver transplantation: lessons learned

Abstract

Background: Aborted donor hepatectomy (ADH) during any stage of living donor hepatectomy (LDH) is a rare event. We describe our experience and discuss the lessons from these events. Methods: From September 2005 to January 2019, 77 of 2 031 (3.79%) LDH were aborted at various stages of surgical procedure due to donor or recipient related reasons. Demographic and clinical data of aborted donor candidates and the clinical course of their potential recipients were analysed. Results: LDH of 77 donor candidates was aborted due to donor (n = 53) or recipient (n = 24) related reasons. The most common donor related reason was the quality of liver parenchyma (n = 31). The most common recipient related reason was haemodynamic instability (n = 11). Twenty-three recipients underwent either living donor liver transplantation (LDLT) (n = 21) or deceased donor liver transplantation (DDLT) (n = 2) at a median of 6 days following ADH. In one aborted due to a donor reason and two aborted for recipient reasons, LDLT was performed using the same donor candidates. Thirty-six recipients had no liver transplantation (LT) and died a median of 17.5 days following ADH. Conclusions: We believe that ADH will decrease with experience and meticulous preoperative clinical and radiological evaluations. Abandoning the donor hepatectomy is always a valid option at any stage of the surgery when the unexpected is encountered.

Diagnostic and Therapeutic Management Algorithm for Biliary Complications in Living Liver Donors

“…To date, we have tried to find cases of HJ reported in LLDs. A total of 15 HJs were reported in 9 published studies except four cases of HJ that was reported from our institute (Table 1) [4][5][6]14,[17][18][19][20][21][22][23][24] In the present study, the rate of HJ among those who experience biliary complications was 0.56%. HJ is a major operation performed for the management of biliary complications following LDH.…”

“…Our detailed donor evaluation scheme and information regarding our aborted donor hepatectomies were emphasized in a recent study from our institute. 4 Currently, LLDs are chosen among individuals aged between 18 to 60 years of age with normal renal and liver functions. However, in the early years of our experience, donors [?]…”

Auxiliary liver xenotransplantation technique in a transgenic pig‐to‐non‐human primate model: A surgical approach to prolong survival

“…Subsequently, living donor liver transplantation has gained popularity in an attempt to resolve such a hurdle and is being more frequently performed, especially in Asia. Despite such effort to close the gap between supply and demand of organs, its impact appears to be minimal, and a large proportion of patients requiring organ transplantation spend considerable time on waitlist before a matched organ is available or clinical deterioration occurs 3–5 …”

“…Despite such effort to close the gap between supply and demand of organs, its impact appears to be minimal, and a large proportion of patients requiring organ transplantation spend considerable time on waitlist before a matched organ is available or clinical deterioration occurs. [3][4][5] Xenotransplantation, the transplantation of organs or tissues between different species, has a long history in scientific exploration.…”