Complications in 100 Living-Liver Donors

Abstract

ObjectiveA review of 100 living-liver donors was performed to evaluate the perisurgical complications of the procedure and thus to help quantify the risks to the donor. Summary Background DataDespite the advantages of living-donor liver transplantation (LDLT), the procedure has received criticism for the risk it imposes on healthy persons. A paucity of data exists regarding the complications and relative safety of the procedure. MethodsOne hundred LDLTs performed between November 1989 and November 1996 were reviewed. Donor data were obtained by chart review, anesthesia records, and the computerized hospital data base. Patient variables were compared by Fisher's exact test and the Student's t test. ResultsThere were 57 women and 43 men with a median age of 29. Donors were divided into two groups: group A (first 50 donors), and group B (last 50 donors). There were 91 left lateral segments and 9 left lobes. There were no deaths. Fourteen major complications occurred in 13 patients; 9 occurred in group A and 5 in group B. Biliary complications consisted of five bile duct injuries (group A = 4, group B = 1) and two cut edge bile leaks. Complications were more common in left lobe resections (55%) than in left lateral segment grafts (10%). Minor complications occurred in 20% of patients. A significant reduction in overall complications (major and minor) was observed between the groups (group A, n = 24 [45%] vs. group B, n = 10 [20%]). In addition, surgical time and hospital stay were both significantly reduced. ConclusionsAlthough the procedure is safe, many LDLT donors have a perisurgical complication. Surgical experience and technical modifications have resulted in a significant reduction in these complications, however. To minimize the risks for these healthy donors, LDLT should be performed at institutions with extensive experience.

Long-term complications of living donor liver transplantation

“…[18][19][20][21] Donor hospital stays routinely were less than 10 days, average donor blood losses were approximately 400 to 800 mL, and the need for heterologous blood transfusion of the donor was uncommon. Grewal et al 20 (University of Chicago, Chicago, IL) and Yamaoka et al 18 (Kyoto University, Kyoto, Japan) each reported outcomes of 100 living liver transplant donors with very similar findings. Interestingly, their data have been mirrored by smaller studies in North America 22 and Europe.…”

“…Biliary complications were the most commonly reported source of donor morbidity, with an overall incidence of 5% to 10%. 18,20,21,23 Leakage of bile prolonged donor hospitalization and was most commonly treated by percutaneous drainage; however, reoperation for the repair of biliary leaks has been reported. There are no data in the literature of long-term sequelae from biliary complications.…”

Whither living donor liver transplantation?

“…The number of psychosocial problems experienced by families 16 and the general reports of fatigue, wound pain, and so on 17 add credence to the notion that there are significant concerns for the welfare of the donor and family. These should not be undervalued.…”

Safe donor hepatectomy for living related liver transplantation

“…6 First, it increases the number of organs that are directly available. Second, most recipients receive their transplant on an elective basis and thus should experience lower morbidity and mortality rates.…”