Donor Complications Including the Report of One Death in Right-Lobe Living-Donor Liver Transplantation

Abstract

Background/Aims: Our objective is to assess donor complications in all right hepatic lobe living-donor liver transplantation (LDLT) at our center. Methods: Of a total of 352 liver transplantations performed, 60 were right-lobe LDLT. Most donors (88.3%) were related to the recipients. Results: Mean hospital stay was 5.4 8 0.6 days. No complications occurred due to preoperative evaluation. Most donors received one or two units of autologous blood transfusion. Only 5 (8.3%) needed nonautologous blood transfusion. Most complications were minor and treated conservatively. Bile leaks from the cut surface of the liver occurred in 5 donors (8.3%). Two patients had potentially fatal complications: perforated duodenal ulcer and portal vein thrombosis (PVT). The donor with perforated ulcer developed septicemia and multiple organ failure. He was discharged from the hospital with hemiparesis due to cerebral ischemia. The patient with PVT remained asymptomatic and the portal vein was recanalized by the 3rd postoperative month. One donor died in the immediate postoperative period of cardiac arrest due to cardiac arrhythmia. Conclusion: Right hepatectomy for LDLT may be associated with significant morbidity, including death and it should be performed only by surgeons with great experience.

Predictive factors of early graft loss in living donor liver transplantation

“…Although the present study only included patients submitted to living donor transplantation, the results were similar to those reported for other Western series involving living or deceased donors (1,9,10,22,25,33) . The most frequent etiology of liver disease that led to liver transplantation was hepatitis C and there was a predominance of males (11,22) .…”

“…Statistical analysis demonstrated the importance of MELD score and GRBW ratio for the prediction of post-transplant outcomes (5,6,27,31,36) . An increase in survival and improved outcomes of living donor liver transplantation were obtained in different series conducted in Europe and the United States when rigorous selection criteria were applied to donors and recipients (9,26,28) . Thus, the establishment of criteria able to predict the success of the procedure is important for the continuous improvement of outcomes, since living donor liver transplantation is a highly complex surgery that involves another healthy subject (donor) who should only be submitted to donation if the chances of success are expressive (2,9) .…”

“…The constant shortage of organ donors is responsible for the failure to meet the growing demand for liver transplantation (9,11,12,15,37) . This imbalance between organ supply and patients awaiting liver transplantation is substantial and is a matter of concern, especially in East Asian countries such as South Korea, Japan, Hong Kong, and Taiwan (21,24,25,26,35,37) .…”

Outcome after living donor liver transplantation: A comprehensive retrospective analysis of the risk factors for morbidity, mortality and graft failure in a tertiary care center

“…In Western countries, most of the organs used for transplantation are obtained from brain stem-dead, heart-beating cadaveric donors. However, the number of organs required to satisfy the needs of transplantation far exceeds the number of cadaveric organs available [1,3,4]. This has prompted a relaxation in deceased donor selection criteria and the use of organs from so called "marginal donors".…”

Occurrence and Spatial Distribution of Hepatitis C in a Western Brazilian Amazon State

“…The HCV infection has high mortality (3) , being a public health problem because it has a high prevalence in the general population, severe comorbidities, the treatment demand high costs and during the terminal phase, the infected individuals progress to chronic stages of the disease, developing cirrhosis and hepa tocellular carcinoma (1) . The liver disease generated by HCV is the most common cause of liver transplan tation in Brazil, and even after transplantation, can recur and progress to cirrhosis (4,6) . Among the risk groups, users of intravenous illicit drugs, individuals on dialysis or who received blood transfusions before 1992, hemophiliacs and impri soned are those with the highest risk, because the main route of transmission is through contaminated blood (8) .…”