Early and late complications in the right-lobe adult living donor

Abstract

Key Points 1. Reported complication rates for right-lobe liver donors vary widely, but are estimated to be approximately 35%, with a surgical mortality rate of approximately 0.3%. 2. Biliary complications, including leak, biloma, or stricture, are the most commonly reported morbidity in rightlobe living donors. 3. Other significant donor morbidity includes portal vein thrombosis, pulmonary embolus, bowel obstruction, bleeding requiring reoperation or transfusion, and incisional hernia. 4. These data underscore the reality that living donation is associated with a small, but real, possibility of death and potentially significant morbidity, emphasizing the need for a comprehensive database to precisely define true living donor morbidity and mortality. (Liver Transpl 2003; 9:S45-S49.)

Analysis of complications in hepatic right lobe living donors

“…In other series, approximately 40% of right-lobe donors experienced at least one complication during the year after the transplant surgery 24. Biliary leakage or stricture complicated the postoperative course in 6% of the donors,25 an observation confirmed by previous reports 2627. Rehospitalization occurred in 8.5% of 75 donors, 5% of whom required reoperation 25.…”

Analysis and Outcomes of Right Lobe Hepatectomy in 101 Consecutive Living Donors

“…To date, it has been difficult to quantitate precisely the risk of morbidity, as many studies under report minor complications (13,14). A crude complication rate of 31% (54 events in 174 donors) has been reported in a review of 12 studies of right lobectomy in live donors by Beavers et al (15).…”

“…We prefer to retain the MHV with the graft when the recipient is critically ill (e.g. MELD >30), in the presence of portal hypertension and when the GWRW ratio is less than 0.9% (14,16,17). The donor, however, is our first consideration and if inclusion of MHV is not possible, we encourage families to explore whether other donor might be available.…”

Current management strategy of hepatocellular carcinoma

“…Primary graft failure and the risk to the donor present ethical concerns that cannot be disregarded. Donor deaths and other complications, such as insufficiency of the donor's remaining liver (which required subsequent transplantation), have been reported [62] . Furthermore, some data also suggest the need to have a better evaluation of the donor, including liver histology [63] .…”