One-year morbidity after donor right hepatectomy

Abstract

Live donors are becoming an increasingly important source of donor organs in liver transplantation; however, long-term functional aspects of recovery from donor right hepatectomy are unknown. We analyzed donor outcomes at 1-year follow-up. We performed a single-center retrospective analysis of 70 right hepatectomy donors. Sixweek and 1-year postoperative follow-up results were compared to preoperative baseline values. Ultrasonography was performed in all donors at 6 weeks and as clinically indicated. All donors were alive and well at the end of the study period. Of 66 right hepatic donors, only 22 (32%) were fully compliant with a 1-year follow-up visit. All those not compliant were contacted by phone. All complications except 1 (late finding of portal vein thrombosis) occurred in the perioperative (90-day) period. The incidence of bile leak was 4.3%, incisional hernia 20%, and autologous transfusion 1.0%. There were no aborted procedures. In those compliant with full 1-year follow-up, total bilirubin, aspartate aminotransferase, and alanine aminotransferase were normal in 97%. A total of 5 donors were noted to have persistence of asymptomatic thrombocytopenia beyond the perioperative period (90 days). These were investigated with Doppler sonography. Sonography was unremarkable in 3 of the 5, while 2 had abnormal findings: splenomegaly alone in 1, and splenomegaly with portal vein thrombosis in the other. Magnetic resonance angiography was performed in both, and the patient with portal vein thrombosis underwent endoscopy, which failed to reveal varices. Neither has clinical portal hypertension. Both remain asymptomatic albeit with stable thrombocytopenia. In conclusion, the majority of complications after donor right hepatectomy occur in the perioperative period. Later findings may include asymptomatic thrombocytopenia, with an incidence possibly as high as 23%, though the significance of this finding remains uncertain. Larger-scale studies are needed to confirm the true incidence and clinical significance of persistent thrombocytopenia in the donor hepatectomy population. Strategies to improve compliance with 1-year follow-up visits need to be developed. O ver the past 6 years, over 1,000 adult living donor (LD) liver transplants using the right lobe have been performed in the United States. Early results suggest that the liver regenerates within a few weeks and liver enzymes return to normal by postoperative day 7. 1 Recent data by 3-dimensional imaging suggests that regeneration is incomplete at 1 year, with total liver volume 83.3% Ϯ 9% of original volume. 2 Other longterm functional aspects of recovery are unknown.Long-term data on morbidity is limited due to a relatively small clinical experience, 3 variability in defining and tracking morbidity across centers, and poor long-term compliance with follow-up by LDs. Studies in the literature report early morbidity ranging from 0 to 67%, varying from simple quality of life changes to serious medical complications such as bile leaks. 4 Longterm follow-up data o...

Donor quality of life before and after adult-to-adult right liver live donor liver transplantation

“…Such analysis would not be possible or appropriate in programs with poor donor compliance to follow-up. 31 The results of this study reflected the temporary nature of the donors' disabilities. Some authors have suggested a 10-points change in any SF-36 domain or more than 10% change as being clinically meaningful.…”

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

“…The safety of living liver donors is of paramount importance and this issue has been aggressively discussed so far (10)(11)(12)(13)(14)(15)(16). Although the liver has a capacity to regenerate, it is generally believed that the larger the resected liver parenchyma is, the more frequently postoperative complications will occur (13,14,17,18).…”

Cicatrização da parede abdominal após hepatectomia parcial

“…In spite of the progress of surgical techniques and better postoperative follow-up, literature information shows that the incidence of healing failures has not changed in recent years 3,4,9 . Works suggest that posthepatectomy scars are less resistant than for other surgical procedures 4,7,18 . It was demonstrated that there is an increase in collagen synthesis in the remaining liver after partial hepatectomy until the 7 th day, this difference no more existing from the 14 th day on.…”

“…Similar situation is described for patients undergoing partial hepatectomies. Rudow et al 7 reported an incidence of 20%, while D'Angelica et al 8 , 9.8%. According to Van't et al 9 , most severe situations with evisceration led 25% of patients to death within 60 days.…”