Morbidity and Mortality of Hepatic Right Lobe Living Donors: Systematic Review and Perspectives

Abstract

Background & Aims: The main restriction in the development of adult-adult Living Donor Liver Transplantation (LDLT) is the risk of morbidity and mortality for donors, which raises ethical questions. The objectives of this study are to review published studies dealing with morbidity and mortality in LDLT and to identify the proposed management and strategies for preventing donor mortality and morbidity in LDLT.Methods: The Medline database was searched from 2000 to 2017 using the MeSH terms “liver transplantation” and “morbidity” or “mortality” in combination with keywords “living donor liver transplantation”.Results: Among the 382 articles obtained, 43 articles were relevant for morbidity, 15 for mortality and 6 for both morbidity and mortality. Twenty-three papers reported donor deaths. The major cause of death was sepsis (30%). Morbidity ranged from 10% to 78.3% depending on the studies.Conclusions: The living donors’ morbidity and mortality is high, currently representing the main restriction in the development of LDLT. Some promising techniques, such as the donor portal vein flow modulation could lead to the further development of LDLT.

Right posterior segment graft for living donor liver transplantation: A systematic review

“…Recipients of the RPS grafts had the following risks of postoperative complications: overall mortality rate of 14.5%, bile leakage of 8.7%, biliary stenosis of 18.8%, hepatic artery thrombosis of 8.7%, and liver re-transplantation of 2.9%. A recent review regarding RL procurement has reported 23 donor deaths between 1999 and 2017, and high morbidity ranging from 10% to 78.3% [7]. Regarding recipients' outcome, two of the included studies reported outcome in the RPS graft and the RL graft [13,15].…”

“…Donation of the right lobe (RL) graft is limited by the minimal liver remnant in order to avoid small-for-size risk for the donor [5,6]. Furthermore, a recent review has shown that morbidity and mortality of RL procurement still remains a concern, leading to a restriction in the development of LDLT [7].…”

Global experience and perspective on anonymous nondirected live donation in living donor liver transplantation

“…As centers gained more experience, the number of procedures performed in the United States peaked in 2001 at approximately 10% of total adult liver transplants but has since remained 5% (Figure 1, Panel A). A highly publicized live liver donor mortality in 2001 and adoption of the MELD‐based organ allocation in 2002 are factors which may have contributed to the decline in LDLT since the early 2000s in the United States …”

Donor Surgical Morbidity in Pediatric Living-Donor Liver Transplant: A Portuguese Experience

“…Even though donor mortality is a rare event (0.5% for right hepatectomy and 0.1-0.3% for left hepatectomy [ 2 3 ], it should be addressed as a catastrophe as it affects the recipient, the families of both the donor and recipient, and all of the clinicians involved in the LDLT process. From 1999 to 2017, 23 deaths worldwide have been reported [ 11 ]. All efforts should be made to minimize the possibility of donor mortality.…”