Adult Living Liver Donors have Excellent Long-Term Medical Outcomes: The University of Toronto Liver Transplant Experience

Abstract

Right lobe living donor liver transplantation is an effective treatment for selected individuals with end-stage liver disease. Although 1 year donor morbidity and mortality have been reported, little is known about outcomes beyond 1 year. Our objective was to analyze the outcomes of the first 202 consecutive donors performed at our center with a minimum follow-up of 12 months (range 12-96 months). All physical complications were prospectively recorded and categorized according to the modified Clavien classification system. Donors were seen by a dedicated family physician at 2 weeks, 1, 3 and 12 months postoperatively and yearly thereafter. The cohort included 108 males and 94 females (mean age 37.3 ± 11.5 years). Donor survival was 100%. A total of 39.6% of donors experienced a medical complication during the first year after surgery (21 Grade 1, 27 Grade 2, 32 Grade 3). After 1 year, three donors experienced a medical complication (1 Grade 1, 1 Grade 2, 1 Grade 3). All donors returned to predonation employment or studies although four donors (2%) experienced a psychiatric complication. This prospective study suggests that living liver donation can be performed safely without any serious late medical complications and suggests that long-term follow-up may contribute to favorable donor outcomes.

Live Donor Liver Transplantation: A Valid Alternative for Critically Ill Patients Suffering From Acute Liver Failure

“…However, donor and recipients are properly advised of the morbidity and mortality rates as well as of the long-term outcomes at our program so that they can make an informed decision about whether they opt for live donation or wait for a deceased donor. Based on the present and previous analysis (16,22), we believe that is appropriate to continue to offer LDLT to ALF patients, since the survival achieved is similar to the one obtained with DDLT (1, 3-5 year survival for DDLT: 92% vs. LDLT: 86%; p ¼ 0.63) and donor morbidity can be kept to the minimum.…”

“…Being active on the waiting list for deceased donor transplantation is a requirement before any living donor discussion can be initiated. Potential donors and recipients are advised of the morbidity and mortality rate based on the program experience (16,17). Also, they are informed that, at our institution, recipients overall survival rate for LDLT and DDLT is similar (18).…”

Treatment with Optifast reduces hepatic steatosis and increases candidacy rates for living donor liver transplantation

“…(3) Patients with suspected nonalcoholic steatohepatitis (NASH), based on deranged liver enzymes without an alternate cause, were not considered for Optifast treatment.…”

Intraoperative events and their outcome: Data from 4007 laparoscopic interventions by the French “Club Cœlio”

“…The Clavien classification was originally meant to deal with complications occurring during open surgery, and mostly for ''major'' surgery: carcinologic liver, esophagus and pancreas resections as well as organ transplantation [10,11]. One of the strong points of this now timehonored, widely recognized classification is that it grades complications according to their therapeutic consequences.…”