Comparison of Right Lobe Donor Hepatectomy with Elective Right Hepatectomy for Other Causes in New York

Abstract

This study represents one of the first unsolicited regional analyses of donor morbidity and resource utilization for RLDH and further emphasizes the need and utility of a live donor registry.

Right hepatectomy with extra-hepatic vascular division prior to transection: intention-to-treat analysis of a standardized policy

“…This rate was only 5.5% in the present series. The peri‐operative RBC transfusion rate (17%) was also similar to previous series of major hepatectomy in non‐cirrhotic patients, in which it varies largely from 6% to 63%, as it may depend on centres transfusion policies 10,26,27,30,48,49,51,53,54 . In addition, as expected from the partial outflow control enabled by the technique, 25 the incidence of clinical air embolism was nil in the present series, although damage to the middle hepatic vein is still possible.…”

“…Post‐operative mortality and morbidity rates (1.6% and 42% respectively) were comparable to previous series of major hepatectomy in non‐cirrhotic patients 10,26,27,30,40,48,49,51,53,54 . The prospective collection of post‐operative data and the strict accordance to the five‐tier grading of the Dindo and Clavien classification, 22 may explain the high rate of overall morbidity, whereas less than 20% of patients experienced morbidity of grade II and more.…”

“…Post-operative mortality and morbidity rates (1.6% and 42% respectively) were comparable to previous series of major hepatectomy in non-cirrhotic patients. 10,26,27,30,40,48,49,51,53,54 The prospective collection of post-operative data and the strict accordance to the five-tier grading of the Dindo and Clavien classification, 22 may explain the high rate of overall morbidity, whereas less than 20% of patients experienced morbidity of grade II and more. Moreover, every single complication and its associated grade of severity was reported in detail (Table 4) in order to present a comprehensive analysis of the outcome after a right hepatectomy with the unclamping policy.…”

Live liver donors’ risk thresholds: risking a life to save a life

“…Probability trade-off has been shown to capture the complexities of clinical decisions that are made under conditions of uncertainty and has demonstrated high coefficients of test-retest reliability (0.78-0.94). 40,41 The method is able to determine how strongly individuals adhere to their treatment preferences 34,39 and allows an assessment of potential donor Donors who developed wound infections 20% 15 Donors who developed postoperative urinary infections 10% 15 Donors who developed incisional hernias 5-20% 15,122 Donors who developed postoperative liver failure requiring liver transplantation 0.20% 123 Donors who experienced postoperative depression that resolved 2-14% 116,117,122,124 Donors' risk of death Risk of death for donors as a result of surgical complications 0.1-0.5% 15,62,102,123,125 Donors' operation Donors in whom an incision was made but who were unable to donate because of an unexpected finding during the operation 2-4.9% 15,103,119,126 Donors who needed at least one unit of blood transfused during or after surgery 1-4.9% 107,121,127 Mean donor blood loss during surgery 500-750 ml 107 Donors' recovery Mean hospital stay for the donor after surgery 6-7 days 73,[120][121][122]127 Time necessary for donors to recover completely from surgery 2-14 weeks 73,116 Donors' long-term sequelae Donors who experienced at least one complication after 1 year from donation 7% 15 Donors who needed to be readmitted to hospital after being discharged home 7-11% 121,122 Donors who needed to change their job as a consequence of their ...…”