Donor safety and remnant liver volume in living donor liver transplantation

Abstract

Living donor liver transplantation is now a common practice in countries in which the availability of cadaveric organs is limited. The preoperative preparation, intraoperative surgical technique, and postoperative care of donors and recipients have evolved in recent years. We retrospectively compared 67 donors with a remnant liver volume equal to or more than 30% (group 1) with 14 donors who had less than 30% remnant liver volume (group 2) for donor outcomes. All the complications in donors were systematically classified. Donors with less than 30% remnant liver volume showed significantly higher peak aspartate aminotransferase, alanine aminotransferase, international normalized ratio, and bilirubin levels. There were 6 complications in group 1 and 4 complications in group 2. The difference between the 2 groups in terms of donor complications did reach statistical significance (P ϭ 0.043); donors with a remnant liver volume Ͻ 30% had a 4 times greater relative risk of morbidity.In conclusion, the use of donors with less than 30% remnant liver volume is highly debatable as donor safety should be of utmost importance in living donor liver transplantation. Living donor liver transplantation (LDLT) is now an accepted treatment modality for end-stage liver disease. It has become an alternative in the era of organ shortage. This procedure is possible because of the segmental structure of the liver and the regeneration potential of the transplanted and remnant parts. After years of extensive experience in adult-to-child left-lobe liver transplantation, right donor hepatectomy has become a common practice in centers performing adult-to-adult LDLT. Despite impressive results, right-lobe LDLT involves one of the most complicated and technically demanding surgical procedures and has created considerable controversy with respect to donor safety. To date, there have been 17 donor deaths reported, and the morbidity is reported to be in the range of 20% to 30%.

Revisiting the Safety of Living Liver Donors by Reassessing 441 Donor Hepatectomies: Is a Larger Hepatectomy Complication-Prone?

“…Several surgeons documented the accepted lower safety margin of donor remnant liver volume might be 30% of the total liver volume in LDLT (24)(25)(26)(27). Transplant surgeons have to set strict limitation for the safety margin of remnant liver volumes.…”

Families and Medical Decisions to Assume Risks for the Benefit of Others

“…Living donation turns a healthy person (the donor) into a patient who is exposed to numerous risks, including the risks of surgery, and who ends up minus a healthy body part (kidney) or part of a healthy body part (liver). Physical and psycho-social risks have been documented (Jowsey and Schneekloth 2008;Lentine et al 2012;Friedman et al 2006;Young et al 2008;Soneji et al 2008;Boudville et al 2006;DuBay et al 2009;Parolin et al 2004;Taner et al 2008;Middleton et al 2006;Parikh et al 2010). (For further discussion of the experiences of living donors, see DuBois et al 2012.…”

Review of anesthesia in liver transplantation

“…An insufficient liver graft volume for the recipient, defined as a graft volume of less than 0.8% 87 to 1% 88 of the recipient body weight, may result in small-for-size syndrome in the recipient, 87 which may develop to liver dysfunction, liver failure, and graft loss. 88e90 Meanwhile, donors with a remnant liver volume of less than 30% of their preoperative volume may face up to four times higher risk of postoperative morbidity, 91 including postoperative hepatic insufficiency and failure. 37 The hepatic insufficiency can be so severe that LT for the donor may be required to treat the hepatic failure.…”