Selection of the Living Liver Donor

Sterneck, Martina; Fischer, Lutz; Nischwitz, Ulrike; Burdelski, M.; Kjer, S.; Latta, A.; Malagó, Massimo; Petersen, Jörg; Pothmann, W.; Rogiers, Xavier; Broelsch, Christoph E.

doi:10.1097/00007890-199510150-00009

Cited by 106 publications

(71 citation statements)

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“…In our cohort of patients, 17 of 26 potential donors (65%) who underwent formal evaluation were found medically suitable. In the 4 studies cited, [5][6][7][8] between 64% and 89% of the potential donors were accepted as donors after formal evaluation, which is very similar to our cohort.…”

Section: Evaluation For Living Donor Liver Transplantationsupporting

confidence: 82%

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Evaluation of 100 patients for living donor liver transplantation

Trotter¹,

Wachs

Trouillot³

et al. 2003

Liver Transpl

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The initial success of living donor liver transplantation (LDLT) in the United States has resulted in a growing interest in this procedure. The impact of LDLT on liver transplantation will depend in part on the proportion of patients considered medically suitable for LDLT and the identification of suitable donors. We report the outcome of our evaluation of the first 100 potential transplant recipients for LDLT at the University of Colorado Health Sciences Center (Denver, CO). All patients considered for LDLT had first been approved for conventional liver transplantation by the Liver Transplant Selection Committee and met the listing criteria of United Network for Organ Sharing status 1, 2A, or 2B. Once listed, those patients deemed suitable for LDLT were given the option to consider LDLT and approach potential donors. Donors were evaluated with a preliminary screening questionnaire, followed by formal evaluation. Of the 100 potential transplant recipients evaluated, 51 were initially rejected based on recipient characteristics that included imminent cadaveric transplantation (8 patients), refusal of evaluation (4 patients), lack of financial approval (6 patients), and medical, psychosocial, or surgical problems (33 patients). Of the remaining 49 patients, considered ideal candidates for LDLT, 24 patients were unable to identify a suitable donor for evaluation. Twenty-six donors were evaluated for the remaining 25 potential transplant recipients. Eleven donors were rejected: 9 donors for medical reasons and 2 donors who refused donation after being medically approved. The remaining 15 donorrecipient pairs underwent LDLT. Using our criteria for the selection of recipients and donors for LDLT gave the following results: (1) 51 of 100 potential transplant recipients (51%) were rejected for recipient issues, (2) only 15 of the remaining 49 potential transplant recipients (30%) were able to identify an acceptable donor, and (3) 15 of 100 potential living donor transplant recipients (15%) were able to identify a suitable donor and undergo LDLT. Recipient characteristics and donor availability may limit the widespread use of LDLT. However, careful application of LDLT to patients at greatest risk for dying on the waiting list may significantly reduce waiting list mortality. (Liver Transpl 2000;6:290-295.)

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Section: Evaluation For Living Donor Liver Transplantationsupporting

confidence: 82%

“…Sterneck et al 5 reported their experience in the evaluation of 98 pediatric recipients considered for LDLT. Twenty-nine of these 98 potential recipients (29%) were rejected for consideration of LDLT because of primary contraindications in the potential recipients.…”

Section: Evaluation For Living Donor Liver Transplantationmentioning

confidence: 99%

Evaluation of 100 patients for living donor liver transplantation

Trotter¹,

Wachs

Trouillot³

et al. 2003

Liver Transpl

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“…24 The best management of this anomaly in partial liver transplantation has been unclear, and such cases have been contraindicated as potential living liver donors. 25 However, we have not experienced subsequent vascular complications after LRLT using liver grafts from such donors, suggesting that accurate preoperative estimation of the hepatic arterial anatomy ensures that the presence of an aberrant left hepatic artery is not discouraging in LRLT.…”

Section: Discussionmentioning

confidence: 89%

Safe donor hepatectomy for living related liver transplantation

Sugawara

Makuuchi

Takayama

et al. 2002

Liver Transplantation

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Minimizing the risk of donor hepatectomy while preserving graft viability is an important concern in living related liver transplantation. This report describes clinical outcomes for living donor hepatectomy with reference to the type of hepatectomy. Donor hepatectomy was performed in 130 consecutive living donors. They were divided into three groups: left lateral or extended left lateral segmentectomy (group S; n ‫؍‬ 50), left hepatectomy with or without caudate lobe or right lateral resection (group L; n ‫؍‬ 64), and right hepatectomy (group R; n ‫؍‬ 16). Intraoperative and postoperative data were examined and compared among the groups. No critical complications were observed in any group. However, there were differences in donor age, surgical and ischemia times, volume of blood loss, graft weight, and aspartate aminotransferase level elevation among the groups. Livers showed a substantial increase in volume, tending to the standard liver volume 1 month after surgery. Regardless of the extent of donor hepatectomy, serious complications did not occur after surgery. Surgical risk for a living donor is minimal if the operation is performed by experienced surgeons using present procedures. (Liver Transpl 2002;8:58-62.)

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“…However, some of the deaths of living donors reported in North American and European series were related to deep venous thrombosis (DVT) and pulmonary embolism (PE). [2][3][4] Hypercoagulability has been recognized as a factor that contributes to the occurrence of thromboembolic complications after orthopedic, 5 laparoscopic, 6 vascular, 7,8 urologic, 9,10 abdominal, 11 and hepatic 12 surgery. The underlying mechanisms are pleomorphic and include the release of thromboplastin and serotonin from damaged tissues and platelets, 5 the increase of procoagulant factors induced by an interleukinmediated (interleukin-6, interleukin-8) acute phase response, the reduction of anticoagulant factors determined by increased consumption, blood loss, or hemodilution.…”

mentioning

confidence: 99%

Thromboelastogram monitoring in the perioperative period of hepatectomy for adult living liver donation

Cerutti¹,

Stratta²,

Romagnoli

et al. 2004

Liver Transpl

111

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Living donor liver transplantation (LDLT) is becoming a widespread procedure. However, the risk of surgical and medical complications in healthy donors is still a major concern. Hypercoagulability contributes to thromboembolic complications after surgery, but alterations of hemostasis after liver resection are difficult to predict. This study aims to define the perioperative coagulation profile of living liver donors by the use of both routine tests and thromboelastogram (TEG). Ten subjects undergoing right hepatectomy for LDLT were studied. A complete coagulation screening was performed before operation. The coagulation profile was evaluated by platelet count, prothrombin time-international normalized ratio (PT-INR), activated partial thromboplastin time (aPTT), and TEG at the beginning and at the end of surgery, and on days 1, 3, 5, and 10 after operation, while the donors were under low molecular weight heparin (LMWH) prophylaxis. At preoperative screening, no subject showed evidence of a prothrombotic state. In all cases, TEG was normal at the beginning of surgery. In the postoperative period, despite decreased platelet counts, increased PT-INR, and normal aPTT values, TEG evidenced the progressive development of hypercoagulability in 4 subjects on day 5 and in 6 subjects on day 10. One donor with a definitely hypercoagulable TEG on day 5 experienced deep venous thrombosis (DVT) on day 8, which was resolved with therapeutic doses of LMWH. In conclusion, despite routine tests suggesting hypocoagulability and LMWH prophylaxis, TEG monitoring showed the unexpected occurrence of hypercoagulability in the majority of the subjects after hepatectomy for LDLT. TEG monitoring could be useful in the perioperative management of donors to guide antithrombotic treatment and increase the safety of the procedure. (Liver Transpl 2004;10:289 -294.)

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Selection of the Living Liver Donor

Cited by 106 publications

References 0 publications

Evaluation of 100 patients for living donor liver transplantation

Evaluation of 100 patients for living donor liver transplantation

Safe donor hepatectomy for living related liver transplantation

Thromboelastogram monitoring in the perioperative period of hepatectomy for adult living liver donation

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