Liver Regeneration and Surgical Outcome in Donors of Right-Lobe Liver Grafts

Pomfret, Elizabeth A.; Pomposelli, James J.; Gordon, Fredric D.; Erbay, Nazli; Price, Lori Lyn; Lewis, W. David; Jenkins, Roger L.

doi:10.1097/01.tp.0000079064.08263.8e

Cited by 167 publications

(185 citation statements)

References 32 publications

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“…Approximately 40% of right-lobe donors in our series experienced at least one complication. 11 Fortunately, most of these adverse events were minor and self-limited; however, several patients required additional invasive procedures, including surgery. Severe hypophosphatemia was a universal event among donors and may have contributed to some of the observed complications.…”

Section: Donor Morbiditymentioning

confidence: 99%

“…The clinical significance of the observation that liver regeneration is a relatively protracted process in right-lobe liver donors is unclear. 11 In a prospective study from our center, liver regeneration in healthy donors was observed to continue throughout the first postoperative year, with only one donor achieving complete restoration of liver volume. Fortunately, liver function normalizes rapidly after liver donation, well before regeneration is completed.…”

Section: Donor Morbiditymentioning

confidence: 99%

“…Although morbidity for right-lobe liver donation generally is considered to be low, many believe the true complication rate is underestimated. 10,11,24 In December 2000, The National Institutes of Health sponsored an international workshop reviewing the sci-S46 entific, medical, and psychosocial issues associated with LDALT in an attempt to improve the success and applicability of this procedure. An overall morbidity rate of 21% was estimated based on results of several large series of right-and left-lobe living donors in the world literature.…”

Section: Donor Morbiditymentioning

confidence: 99%

“…This is achieved by thorough preoperative evaluation, proper donor education, and informed consent, while providing an opportunity for a donor to reconsider his or her decision. 7,11 In our institution, an independent donor advocate team has been established to ensure that the potential donor's best interests are served during the process of determining donor suitability from a medical, surgical, and psychological standpoint. Preoperative noninvasive imaging with computed tomographic angiography (CTA) or magnetic resonance angiography (MRA) to evaluate hepatic volume, vascular anatomy, and other intra-abdominal pathological states is crucial for surgical planning and has been shown to minimize donor morbidity and mortality.…”

Section: Avoidance Of Complications Preoperative Evaluation Of Live Lmentioning

confidence: 99%

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Early and late complications in the right-lobe adult living donor

Pomfret

2003

Liver Transplantation

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Key Points 1. Reported complication rates for right-lobe liver donors vary widely, but are estimated to be approximately 35%, with a surgical mortality rate of approximately 0.3%. 2. Biliary complications, including leak, biloma, or stricture, are the most commonly reported morbidity in rightlobe living donors. 3. Other significant donor morbidity includes portal vein thrombosis, pulmonary embolus, bowel obstruction, bleeding requiring reoperation or transfusion, and incisional hernia. 4. These data underscore the reality that living donation is associated with a small, but real, possibility of death and potentially significant morbidity, emphasizing the need for a comprehensive database to precisely define true living donor morbidity and mortality. (Liver Transpl 2003; 9:S45-S49.)

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Section: Donor Morbiditymentioning

confidence: 99%

Section: Donor Morbiditymentioning

confidence: 99%

Section: Donor Morbiditymentioning

confidence: 99%

Section: Avoidance Of Complications Preoperative Evaluation Of Live Lmentioning

confidence: 99%

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Early and late complications in the right-lobe adult living donor

Pomfret

2003

Liver Transplantation

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“…In a prospective study by Dayangac et al [7] , procurement of right grafts inclusive of MHV was not associated with any additional donor risk except in SFS-remnants with RV/TLV < 30% (57% complication rate and prolonged postoperative hyperbilirubinemia). Others showed an association between small remnant volume and donor morbidity [1,11,36,37] . In our series the slightly higher bilirubin and INR levels in SFS-remnants probably resulted from a small RV.…”

Section: Table 4 Middle Hepatic Vein Management In Small-for-size -Rementioning

confidence: 99%

Risk of venous congestion in live donors of extended right liver graft

Radtke¹,

Sgourakis²,

Molmenti³

et al. 2015

WJG

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AIM:To investigate middle hepatic vein (MHV) management in adult living donor liver transplantation and safer remnant volumes (RV). METHODS:There were 59 grafts with and 12 grafts without MHV (including 4 with MHV-5/8 reconstructions). All donors underwent our five-step protocol evaluation containing a preoperative protocol liver biopsy Congestive vs non-congestive RV, remnantvolume-body-weight ratios (RVBWR) and postoperative outcomes were evaluated in 71 right graft living donors. Dominant vs non-dominant MHV anatomy in total liver volume (d-MHV/TLV vs nd-MHV/TLV) was constellated with large/small congestion volumes (CVindex). Small for size (SFS) and non-SFS remnant considerations were based on standard cut-off-RVBWR and RV/TLV. Non-congestive RVBWR was based on non-congestive RV. RESULTS:MHV and non-MHV remnants showed no significant differences in RV, RV/TLV, RVBWR, total bilirubin, or INR. SFS-remnants with RV/TLV < 30% and non-SFS-remnants with RV/TLV ≥ 30% showed Prospective Study Risk of venous congestion in live donors of extended right liver graftArnold Radtke, George Sgourakis, Ernesto P Molmenti, Susanne Beckebaum, Vito R Cicinnati, Hartmut Schmidt,Christoph E Broelsch, Massimo Malagó, Tobias Schroeder Radtke A et al . Liver failure in live donors of right grafts 6009May 21, 2015|Volume 21|Issue 19| WJG|www.wjgnet.com no significant differences either. RV and RVBWR for non-MHV (n = 59) and MHV-containing (n = 12) remnants were 550 ± 95 mL and 0.79 ± 0.1 mL vs 568 ± 97 mL and 0.79 ± 0.13, respectively (P = 0.423 and P = 0.919. Mean left RV/TLV was 35.8% ± 3.9%.Non-MHV (n = 59) and MHV-containing (n = 12) remnants (34.1% ± 3% vs 36% ± 4% respectively, P = 0.148. Eight SFS-remnants with RVBWR < 0.65 had a significantly smaller RV/TLV than 63 non-SFSremnants with RVBWR ≥ 0.65 [SFS: RV/TLV 32.4%(range: 28%-35.7%) vs non-SFS: RV/TLV 36.2% (range: 26.1%-45.5%), P < 0.009. Six SFS-remnants with RV/TLV < 30% had significantly smaller RVBWR than 65 non-SFS-remnants with RV/TLV ≥ 30% (0.65 (range: 0.6-0.7) vs 0.8 (range: 0.6-1.27), P < 0.01. Two (2.8%) donors developed reversible liver failure. RVBWR and RV/TLV were concordant in 25%-33% of SFS and in 92%-94% of non-SFS remnants. MHV management options including complete MHV vs MHV-4A selective retention were necessary in n = 12 vs n = 2 remnants based on particularly risky congestive and non-congestive volume constellations. CONCLUSION:MHV procurement should consider individual remnant congestive-and non-congestive volume components and anatomy characteristics, RVBWR-RV/TLV constellation enables the identification of marginally small remnants.

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