Evolution of Donor Morbidity in Living Related Liver Transplantation

Bröering, Dieter C.; Wilms, Christian; Bok, Pamela; Fischer, Lutz; Müeller, Lars; Hillert, C.; Lenk, Christian; Kim, Jong-Sun; Sterneck, Martina; Schulz, Karl‐Heinz; Krupski, G.; Nierhaus, Axel; Ameis, D.; Burdelski, M.; Rogiers, Xavier

doi:10.1097/01.sla.0000146146.97485.6c

Cited by 150 publications

(54 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, major complications are not rare. Some donors may require additional invasive procedures, including surgery [13,14,15,16]. Catastrophic outcomes, such as death and need for liver transplantation, have been reported in the United States, Europe, Japan, and in other countries [11, 13, 18, 20].…”

Section: Discussionmentioning

confidence: 99%

“…Donor safety is the primary concern of living donor transplantation. Despite diligent donor selection and care, several complications, including death, have been reported following living donation of all these organs [13,14,15,16,17]. Donation of the right lobe is considered the riskiest for the donor of all other types of graft [14, 15].…”

Section: Discussionmentioning

confidence: 99%

“…These complications are reported after any major abdominal procedure done under general anesthesia. Improvement in surgical technique, adequate donor selection, and appropriate postoperative care may significantly reduce perioperative morbidity [14]. …”

Section: Discussionmentioning

confidence: 99%

“…Morbidities were divided into four grades according to the classification of Broering et al[ 14] that was designed for LDLT donors. Grade I is any complication that is not life-threatening, does not result in disability, and does not require a therapeutic invasive intervention or the use of drugs, except analgesics, antipyretics, anti-inflammatories, or antiemetic drugs.…”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Donor Complications Including the Report of One Death in Right-Lobe Living-Donor Liver Transplantation

Coelho¹,

Freitas²,

Matias³

et al. 2007

Dig Surg

View full text Add to dashboard Cite

Background/Aims: Our objective is to assess donor complications in all right hepatic lobe living-donor liver transplantation (LDLT) at our center. Methods: Of a total of 352 liver transplantations performed, 60 were right-lobe LDLT. Most donors (88.3%) were related to the recipients. Results: Mean hospital stay was 5.4 8 0.6 days. No complications occurred due to preoperative evaluation. Most donors received one or two units of autologous blood transfusion. Only 5 (8.3%) needed nonautologous blood transfusion. Most complications were minor and treated conservatively. Bile leaks from the cut surface of the liver occurred in 5 donors (8.3%). Two patients had potentially fatal complications: perforated duodenal ulcer and portal vein thrombosis (PVT). The donor with perforated ulcer developed septicemia and multiple organ failure. He was discharged from the hospital with hemiparesis due to cerebral ischemia. The patient with PVT remained asymptomatic and the portal vein was recanalized by the 3rd postoperative month. One donor died in the immediate postoperative period of cardiac arrest due to cardiac arrhythmia. Conclusion: Right hepatectomy for LDLT may be associated with significant morbidity, including death and it should be performed only by surgeons with great experience.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Donor Complications Including the Report of One Death in Right-Lobe Living-Donor Liver Transplantation

Coelho¹,

Freitas²,

Matias³

et al. 2007

Dig Surg

View full text Add to dashboard Cite

show abstract

“…Internationally reported donor morbidity rates range from 0% to 67%, depending on the individual definition and recognition of morbidity, which undoubtedly correlates with the experience and volumes of individual centres. 20 The donor mortality rate has been estimated to be between 0.1% and 0.3%.…”

Section: Living Donor Liver Transplantationmentioning

confidence: 99%

Selection and work-up for liver transplantation

Zuckermann

Loveland

2012

S Afr Med J

View full text Add to dashboard Cite

The primary goal of evaluating patients for liver transplantation (LT) is to identify appropriate candidates and establish a pre-transplantation plan. Prospective patients must first be referred to a transplantation centre for evaluation and, if deemed suitable, for work-up, with a view to being listed for transplantation. South Africa has centres offering LT in Johannesburg and Cape Town. Typically, referred patients are evaluated by a clinician, and further evaluations and tests are performed before the patient is discussed at a multidisciplinary transplantation meeting. Initiating the referral early in the course of disease facilitates improved outcomes, by allowing earlier LT before the establishment of end-stage disease. It is also well described that patients awaiting transplantation (and their families) demonstrate better psychological adaptation when the entire spectrum of issues is approached by a multidisciplinary clinical team.1 It is not uncommon for children to exhibit behavioural problems, depression, poor social adaptation and non-compliance after transplantation, which can be moderated by early counselling after referral. 2 Purpose and policyOrgan availability is the rate-limiting step regarding successful transplantation and a reduction in waiting-list mortality. This is particularly applicable in centres that do not have related living donor programmes, but rely solely on deceased donor organs. Consequently, the decision-making and selection process must be transparent, and a consistent set of evidence-based criteria must be applied to determine whether selection for transplantation is appropriate. IndicationsBorne out by our experience, approximately 50% of paediatric patients requiring LT have biliary atresia.2 However, the indications for LT fall into 5 major categories of liver disease: (i) cholestatic diseases; (ii) metabolic disorders; (iii) fulminant liver failure; (iv) auto-immune hepatitis; and (v) liver tumours. General listing criteriaInfants and children should be listed for LT when there is evidence that hepatic decompensation has occurred, is imminent, or is inevitable based on the natural history of the disease. Clinical endpoints that determine suitability for transplantation may include one or more of the following: severe cholestasis; portal hypertension with/without variceal bleeding; multiple episodes of ascending cholangitis; failure of hepatic synthetic function; malnutrition and failure to thrive; intractable ascites; encephalopathy; unacceptably poor quality of life due to liver disease; and life-threatening complications of stable liver disease, such as hepatopulmonary syndrome. Pre-LT assessment and work-upThe first step in evaluating a potential candidate for LT is to determine the severity and prognosis of the liver disease. A subjective clinical assessment is undertaken together with an objective assessment including comprehensive laboratory and radiological evaluations. The aim of this is to: (i) identify contra-indications that would either exclude LT, require dis...

show abstract

Morbidity in Live Liver Donors

et al. 2005

View full text Add to dashboard Cite

The true extent of morbidity among live liver donors remains poorly understood. In this unique and often high-profile area of surgery, the development of standards for defining and reporting complications would foster a better understanding of the incidence and magnitude of such adverse events (AEs). Design: Retrospective review of AEs among live liver donors. Setting: University-affiliated teaching hospital. Patients and Methods: Of 202 individuals undergoing evaluation for live liver donation, 42 (20.8%) proceeded to surgery. Thirty-four underwent a right lobectomy without the middle hepatic vein; 3, a left lateral segmentectomy. Any event causing a deviation from a patient's ideal course was considered an AE and subsequently classified according to a derived framework. Morbidity was defined as 1 or more AEs. Main Outcome Measures: Incidence, timing, type, severity, and impact of AEs. Results: No deaths or significant hepatic dysfunction occurred. In 5 (12%) of the 42 donors, the hepatectomy was aborted for anatomic reasons before parenchymal transection. Eight (22%) of the remaining 37 experienced 11 AEs, of which 10 completely resolved, whereas 1 AE (3%) resulted in a permanent disability (brachial plexopathy). The overall incidence of AEs was 0.30 per case. Ten (91%) of the 11 AEs presented within the first postoperative month. Conclusions: Most live liver donations are uncomplicated or do not lead to permanent consequence. The adoption of a standards-based classification framework for AEs in live liver donors would allow for an inclusive, consistent, and universally applicable method to collect, analyze, and report donor morbidity.

show abstract

Evolution of Donor Morbidity in Living Related Liver Transplantation

Cited by 150 publications

References 42 publications

Donor Complications Including the Report of One Death in Right-Lobe Living-Donor Liver Transplantation

Donor Complications Including the Report of One Death in Right-Lobe Living-Donor Liver Transplantation

Selection and work-up for liver transplantation

Morbidity in Live Liver Donors

Contact Info

Product

Resources

About