Early Postoperative Pain and its Predictors in the Adult to Adult Living Donor Liver Transplantation Cohort Study

Abstract

Background Little is known about how well postoperative pain is managed in living liver donors, despite pain severity being the strongest predictor of persistent pain with long-lasting disability. Methods We conducted a prospective multicenter study of 172 living liver donors. Self-reported outcomes for pain severity, activity interference, affective (emotional) reactions, adverse effects to treatment, and perceptions of care were collected using the American Pain Society Patient Outcomes Questionnaire-Revised. Mixed effects linear regression was used to identify demographic and psychosocial predictors of subscale scores. Results Donors were young (36.8±10.6) and healthy. Of 12 expert society analgesic recommendations for postoperative pain management, 49% received care conforming to 3 guidelines, and only 9% to 4 or 5. More than half reported adverse effects to analgesic treatment for moderate to severe pain that interfered with functional activity; however, emotional distress to pain was unexpectedly minimal. Female donors had higher affective (Beta=0.88, p=0.005) and adverse effects scores (Beta=1.33, p<0.001). Donors with 2 or more medical concerns prior to surgery averaged 1 unit higher pain severity, functional interference, adverse effects, and affective reaction subscale scores (Beta range 1.06–1.55, all p<0.05). Receiving information about pain treatment options increased perception of care subscale scores (Beta=1.24, p=0.001), while depressive symptoms before donation were associated with lower scores (Beta=-1.58, p=0.01). Conclusions Donors have a distinct profile of pain reporting that is highly influenced by psychological characteristics. Interventions to improve pain control should consider modifying donor behavioral characteristics in addition to optimizing pain care protocols.

Prevalence and Predictors of Patient-Reported Long-term Mental and Physical Health After Donation in the Adult-to-Adult Living-Donor Liver Transplantation Cohort Study

“…However, like our cohort, the clear majority of U.S. living liver donors are nonHispanic Whites. 90 (Living donor ethnicity information is not available for Canada. 91 )…”

Acute Benefits After Liposomal Bupivacaine Abdominal Wall Blockade for Living Liver Donation: A Retrospective Review

“…First, according to the American Transplant Foundation, 12 postoperative pain is a primary concern in persons considering liver donation. Second, the current demand for liver transplants is much greater than the available organ supply; thus, provision of safe and comfortable perioperative experiences influences living donor availability 13 . Finally, postoperative pain has been found to be a major cause of perioperative morbidity and mortality and is, thus, of special consideration in otherwise healthy donor patients 14 …”

Pediatric living donor liver transplantation with large-for-size left lateral segment grafts

“…18 Living donor evaluations were performed as described previously. [18][19][20] Briefly, all potential donors must be between 16 and 60 years of age, be in good health, have a BMI ≤35 kg/m 2 , have a compatible blood group with the recipient, and have the capacity to provide informed consent. In addition to comprehensive medical, surgical, and psychosocial assessments, hepatic vascular and biliary anatomy is evaluated by triphasic computed tomography and magnetic resonance cholangiography.…”

“…Live donor hepatectomies were performed as described previously. 20,21 All grafts consisted of LLS. The following donor, graft, and perioperative characteristics were recorded: age, gender, weight, BMI, and relationship to the recipient.…”