Donor Safety in Adult-Adult Living Donor Liver Transplantation: A Single-Center Experience of 356 Cases

Abstract

BackgroundAs an important means to tackle the worldwide shortage of liver grafts, adult-adult living donor liver transplantation (A-ALDLT) is the most massive operation a healthy person could undergo, so donor safety is of prime importance. However, most previous research focused on recipients, while complications in donors have not been fully described or investigated.Material/MethodsTo investigate donor safety in terms of postoperative complications, the clinical data of 356 A-ALDLT donors in our center from January 2002 to September 2015 were retrospectively analyzed. These patients were divided into a pre-2008 group (before January 2008) and a post-2008 group (after January 2008). Donor safety was evaluated with regard to the type, frequency, and severity of postoperative complications.ResultsThere were no donor deaths in our center during this period. The overall complication rate was 23.0% (82/356). The proportion of Clavien I, II, III, and IV complications was 51.2% (42/82), 25.6% (21/82), 22.0% (18/82), and 1.2% (1/82), respectively. In all the donors, the incidence of Clavien I, II, III, and IV complications was 11.8% (42/356), 5.9% (21/356), 5.1% (18/356), and 0.3% (1/356), respectively. The overall complication rate in the post-2008 group was significantly lower than that in the pre-2008 group (18.1% (41/227) vs. 32.6% (42/129), P<0.01). Biliary complications were the most common, with an incidence of 8.4% (30/356).ConclusionsThe risk to A-ALDLT donors is controllable and acceptable with improvement in preoperative assessment and liver surgery.

Donor safety in living donor liver transplantation: The Korean organ transplantation registry study

“…The volume of the liver graft should be determined to ensure the absolute safety of the donor but also to meet the need of the recipient. Insufficient RLV has been reported to be a major risk factor for donor mortality and morbidity . The RLV should be no less than 30%‐35% of the initial whole liver volume according to the International Liver Transplantation Society Guidelines .…”

“…Insufficient RLV has been reported to be a major risk factor for donor mortality and morbidity. (24)(25)(26) The RLV should be no less than 30%-35% of the initial whole liver volume according to the International Liver Transplantation Society Guidelines. (9) However, Kim et al reported that there was no significant difference in overall complication between RLV < 30% and RLV 30% in liver donor with a preserved middle hepatic vein (MHV), age < 50 years, and no or mild fatty changes.…”

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“…Overall, morbidity ranges between 17% and 40% in most analyses. [18][19][20][21][22][23][24][25][26][27] Major complications appear in 2% to 13% of cases. This is in line with the findings of the present analysis where we found a 36% complication rate, with most of these patients having minor complications and approximately 5% of all patients having major (grade II) complications.…”

Cultura de segurança no processo de doação de órgãos: revisão de literatura

“…(16,24) The findings enabled the understanding that when greater patient involvement is obtained in the manipulation of medications, a greater level of treatment adherence is achieved, leading to an improvement in the patient's clinical condition, reducing infection rates, re-admission, and graft rejection. (12,(21)(22)(23) Category 2 -Culture of patient safety in the transplant units The category presents questions related to the safety culture of patients undergoing renal, (18,19) hepatic, (11) abdominal, (24) pancreatic, (20) and bone marrow transplantation, (14) in the pre-and intra-operative periods.…”

“…With regard to the prevention of possible irregularities and complications, it was noted that the use of prophylactic antibiotics, as well as biopsies, was strategies that could minimize the risk of infections and prevent other health events, such as early rejection. (11,19,20)…”