Complications of living donor hepatic lobectomy-A comprehensive report

M. M. Abecassis*, R. A. Fisher, K. M. Olthoff, C. E. Freise, D. R. Rodrigo, B. Samstein, I. Kam, R. M. Merion

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

193 Scopus citations

Abstract

A wider application of living donor liver transplantation is limited by donor morbidity concerns. An observational cohort of 760 living donors accepted for surgery and enrolled in the Adult-to-Adult Living Donor Liver Transplantation cohort study provides a comprehensive assessment of incidence, severity and natural history of living liver donation (LLD) complications. Donor morbidity (assessed by 29 specific complications), predictors, time from donation to complications and time from complication onset to resolution were measured outcomes over a 12-year period. Out of the 760 donor procedures, 20 were aborted and 740 were completed. Forty percent of donors had complications (557 complications among 296 donors), mostly Clavien grades 1 and 2. Most severe counted by complication category; grade 1 (minor, n = 232); grade 2 (possibly life-threatening, n = 269); grade 3 (residual disability, n = 5) and grade 4 (leading to death, n = 3). Hernias (7%) and psychological complications (3%) occurred >1 year postdonation. Complications risk increased with transfusion requirement, intraoperative hypotension and predonation serum bilirubin, but did not decline with the increased center experience with LLD. The probability of complication resolution within 1 year was overall 95%, but only 75% for hernias and 42% for psychological complications. This report comprehensively quantifies LLD complication risk and should inform decision making by potential donors and their caregivers. This large multicenter series from the A2ALL consortium provides a definitive report of the incidence and severity of live liver donor complications, and includes long-term follow-up allowing for a definition of the natural history of complications.

Original languageEnglish (US)
Pages (from-to)1208-1217
Number of pages10
JournalAmerican Journal of Transplantation
Volume12
Issue number5
DOIs
StatePublished - May 2012

Keywords

  • Death risk
  • donation
  • donor outcomes
  • liver transplant
  • living donor

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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