Acute Pancreatitis: A Rare but Serious Complication for Living Liver Donors; Risk Factors and Outcomes

Abstract

Objectives: The purposes of this study were to determine the incidence of acute pancreatitis after living donor hepatectomy and to investigate potential risk factors and outcomes. Materials and Methods: Clinical data of all donors who underwent donor hepatectomy between January 2015 and December 2016 in our liver transplant institute were reviewed. Donor data were obtained from a prospectively maintained database. The donors were divided into 2 groups according to whether they developed postoperative pancreatitis. The following data were compared between the 2 groups: demographic information (age, sex), body mass index, type of hepatectomy (right, left, or left lateral), intraoperative cholangiographic findings, operative time, blood loss, graft data (graft weight, remnant liver ratio), duration of postoperative hospital stay, and postoperative morbidity and mortality (if any). Pancreatitis severity and treatment outcomes were also examined in patients with postoperative pancreatitis. Results: Our study included 348 donors who underwent donor hepatectomy for living-donor liver transplant. Postoperative pancreatitis developed in 6 donors (1.7%). We found no statistical differences between patients with and without postoperative pancreatitis in terms of demographic and intraoperative findings. Neither loco-regional nor systemic complications of pancreatitis developed in any of the patients. Therefore, all were classified as having mild pancreatitis according to revised Atlanta classification. The mean APACHE II score was 5.2 ± 1.2 points (range, 4-7 points). All patients with postoperative pancreatitis received conservative-supportive treatment. Conclusions:Although postoperative pancreatitis is a rarely reported complication in living liver donors, it should always be considered, especially in patients who unpredictably deteriorate in the postoperative period. Proper recognition and timely treatment can help avoid serious consequences. Key words: Hepatectomy, Liver transplantation, Postoperative complications IntroductionThe number of liver transplants has gradually increased, while the shortage of deceased donor organs continues to be a worldwide problem. In the United States, more than 16 000 patients are currently on wait lists for livers according to the Organ Procurement and Transplantation Network. More than 2000 candidates from this list die every year, although over 7000 liver transplants are performed annually in the United States. 1 Living-donor liver transplant (LDLT) is the main alternative solution to reduce the shortage of organs.The first LDLT was performed in Brazil in 1988, and the first successful case was reported in Australia. 2,3 The first adult-to-adult living donor liver transplant (A2ALL) was performed in Hong Kong in 1993. 4 Today, LDLT accounts for approximately 5% of liver transplants performed in the United States. 1 In some countries, like ours, this rate reaches over 80%.Beyond reducing the number of patients on wait lists, LDLT has some potential advantages, including detail...