Anesthetic risks for donors in living-related liver transplantation: analysis of 30 cases

Akpek, Elif; Arslan, G.; Erkaya, Cigdem; Donmez, Ash; Kayhan, Zeynep; Karakayalı, H.

doi:10.1111/j.1432-2277.2003.tb00353.x

Cited by 10 publications

(6 citation statements)

References 16 publications

(14 reference statements)

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“…The proponents of epidural analgesia advocate its relatively safe and effective means of pain control in living liver donors 3, 9. However, others have discouraged its use because of an anticipated postoperative derangement of the coagulation profile and various possible complications, including PDPH, infection, nausea, and vomiting 15–17. Moreover, severe neurological complications (spinal hematoma or cauda equina syndrome) after epidural analgesia are rare events but should be considered when choosing a postoperative analgesic regimen because the risk may be increased in liver donors with intraoperative heparin use and impaired postoperative coagulation 18, 19.…”

Section: Discussionmentioning

confidence: 99%

Intrathecal morphine combined with intravenous patient-controlled analgesia is an effective and safe method for immediate postoperative pain control in live liver donors

Choi

Gwak

et al. 2009

Liver Transpl

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The healthy condition of living donors makes their tolerance to pain particularly low, and clinicians are often challenged to come up with an analgesic technique that is effective yet ensures donor safety. This study compared, in donor right hepatectomy, the efficacy and safety of preoperative intrathecal morphine (ITM) combined with intravenous patient-controlled analgesia (IV-PCA) with IV-PCA alone. Forty adult patients were randomly allocated into 2 groups: ITM؉IV-PCA group (n ‫؍‬ 20) and IV-PCA-only group (n ‫؍‬ 20). Patients in the ITM؉IV-PCA group received morphine sulfate (400 g). The visual analog scale (VAS) at rest and when coughing and supplementary meperidine and IV-PCA (fentanyl) consumption were assessed at 2, 4, 6, 8, 10, 12, 18, 24, 30, 36, 42, 48 56, 64, and 72 hours after surgery. Also, side effects such as sedation, dizziness, nausea, vomiting, pruritus, and respiratory depression were evaluated. The ITM؉IV-PCA group showed significantly less pain at rest and when coughing for up to 30 hours and 24 hours, respectively. Cumulative postoperative consumption of meperidine and IV-PCA (fentanyl) were significantly less in the ITM؉IV-PCA group. The incidence of side effects were comparable between the 2 groups except for pruritus; its incidence was significantly higher in the ITM؉IV-PCA group during the first 24 hours, but no treatment was required due to its mild severity. The results of our study suggest that preoperative ITM combined with IV-PCA may be considered as an effective and safe pain management regimen in living liver donors who have characteristics of low tolerance to pain and postoperative coagulation derangement. Liver Transpl 15:381-389, 2009.

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Section: Discussionmentioning

confidence: 99%

Intrathecal morphine combined with intravenous patient-controlled analgesia is an effective and safe method for immediate postoperative pain control in live liver donors

Choi

Gwak

et al. 2009

Liver Transpl

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“…The introduction of LDLT has significantly expanded the scarce donor pool in countries in which the growing demands of organs are not met by available deceased donor grafts (2). Living donor hepatectomy appears to be a safe procedure, but the extent of morbidity or mortality of living liver donors is underestimated (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Anesthesia-Related Complications in Living Liver Donors: The Experience from One Center and the Reporting of One Death

Özkardeşler

Özzeybek

Alaygut

et al. 2008

American Journal of Transplantation

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Living donor liver transplantation has become an alternative therapy for patients with end-stage liver disease. Donors are healthy individuals and donor safety is the primary concern. The objective of this study was to evaluate the anesthetic complications and outcomes for our donor cases; we report one death. The charts of the patients who underwent donor hepatectomy from February 1997 to June 2007 were retrospectively reviewed. Right hepatectomy (resection of segments 5-8) was done in 101 donors, left lobectomy (resection of segments 2-3) in 11 donors, and left hepatectomy (resection of segments 2-4) in one donor. Minor anesthetic complications were shoulder pain, pruritus and urinary retention related to epidural morphine, and major morbidity included central venous catheter-induced thrombosis of the brachial and subclavian vein, neuropraxia, foot drop and prolonged postdural puncture headache. One of 113 donors died from pulmonary embolism on the 11th postoperative day. This procedure has some major risks related to anesthesia and surgery. Although careful attention will lower complication rate, we have to keep in mind that the risks of donor surgery will not be completely eliminated.

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“…If we compare our intraoperative data on surgery time, blood loss and the substituted amount of blood to the data of 30 LDLTx patients from the literature, who only have left-sided lobectomy or left lateral lobectomy [13], we can underline the excellent peri-and post-operative course of our donor surgery (short times of surgery, minimal blood loss, very short times in the ICU). This can be accomplished because of the above-mentioned expert knowledge of liver resection in the centre.…”

Section: Disadvantages For the Recipientmentioning

confidence: 99%

Heidelberg's first experiences in establishing a living-donation liver transplantation programme

Mehrabi

Schemmer²,

Schmidt³

et al. 2004

Nephrology Dialysis Transplantation

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Background. Since indications for liver transplantation (LTx) have increased and the shortage of brain dead transplant organs continues, an increase in deaths related to extended waiting periods can be documented. Living-related LTx (LRLTx) is a good alternative that can help compensate the shortness of organs for transplantation and can reduce waiting periods and deaths related to a long waiting list. We started a LRLTx programme at the transplantation centre, Department of Surgery at the University of Heidelberg to increase our transplantation activities. In this article we present our primary experiences and protocol. Methods. From September 2002 to June 2003, three LRLTx were performed. Indications in recipients were hepatocellular carcinoma in two cases and liver cirrhoses due to hepatitis B in one patient. Two patients received the right liver (segments V-VIII) of their donors. One patient received the complete liver collected as a Domino LTx. All liver transplants were performed without the use of a venous bypass. Results. The peri-and post-operative courses of our donors were without complications, except for an infected intraabdominal bilioma, which was drained interventionally. The donors were fully able to work after the operation. The coordinative and logistical work should not be underestimated. Conclusions. This therapy should only be offered and performed in centres with excellent expert knowledge in liver and transplantation surgery.

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Anesthetic risks for donors in living-related liver transplantation: analysis of 30 cases

Cited by 10 publications

References 16 publications

Intrathecal morphine combined with intravenous patient-controlled analgesia is an effective and safe method for immediate postoperative pain control in live liver donors

Intrathecal morphine combined with intravenous patient-controlled analgesia is an effective and safe method for immediate postoperative pain control in live liver donors

Anesthesia-Related Complications in Living Liver Donors: The Experience from One Center and the Reporting of One Death

Heidelberg's first experiences in establishing a living-donation liver transplantation programme

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