Live liver donors: Are they at a higher risk for post-operative thrombotic complications?

Abstract

Live liver donor transplantation to adult recipients is becoming a common practice, increasing the organ pool and providing an alternative to whole cadaveric liver transplantation. These patients are healthy adults without serious medical conditions and typically have normal coagulation profiles preoperatively. Right hepatic lobectomy is usually performed for adult recipients, while left hepatic lobectomy is performed for pediatric recipients. Removal of the whole right lobe from the donors may expose theses patients to multiple intraoperative and postoperative complications. Hypercoagulability has been identified as a serious complication which leads to thromboembolic phenomena with potential fatal consequences. The primary aim of this review is to look at possible changes in post-operative coagulation dynamics that may increase the risk for development of thromboembolic complications in live liver donors. In this article, we stress the importance of addressing the issue that conventional clotting tests (PT, INR, PTT) are unable to detect a hypercoagulable state, and therefore, we should examining alternative laboratory tests to improve diagnosis and early detection of thrombotic complications. Measurement of natural anticoagulant/ procoagulant biomarkers combined with conventional coagulation studies and thromboelastography offers a more accurate assessment of coagulation disorders. This allows earlier diagnosis, permitting appropriate intervention sooner, hence avoiding potential morbidity and mortality. Biomarkers that may be evaluated include, but are not limited to: protein C, soluble P-selectin, antithrombin Ⅲ, thrombin-antithrombin complex, and thrombin generation complex. LIVE LIVER DONORS: ARE THEY AT A HIGHER RISK FOR POST-OPERATIVE THROMBOTIC COMPLICATIONS?As the result of an increasing number of patients with end-stage liver disease awaiting liver transplantation, an increased number of centers performing liver transplantations and due to the encouraging results from living-related pediatric transplantation, adult to adult living donor liver transplantation is becoming an increasingly popular option. However, in pediatric live-donor liver transplantation typically uses the donor liver's left lobe or fewer segments resulting in less dramatic effects on the postresection donor's hepatic functions. The overall immediate postoperative complications which are related to the

First Experience in Living Liver Donation From Donors With Sickle Cell Trait

“…The potentially hypercoagulable state in SCT, in addition to inducing a proinflammatory thrombophilic situation during major liver resection, has been a major concern in accepting SCT carriers as donors. 24-26 This concern is supported by US reports of hospitalized black male SCT carriers having a 2× to 4× higher risk for venous thromboembolism. 27…”

“…The potentially hypercoagulable state in SCT, in addition to inducing a proinflammatory thrombophilic situation during major liver resection, has been a major concern in accepting SCT carriers as donors. [24][25][26] This concern is supported by US reports of hospitalized black male SCT carriers having a 2× to 4× higher risk for venous thromboembolism. 27 We therefore implemented an aggressive thromboembolic prophylaxis with SC heparin or low-molecular-weight heparin plus pneumatic intermittent compression devices in all donors.…”

“… 24 - 26 This concern is supported by US reports of hospitalized black male SCT carriers having a 2× to 4× higher risk for venous thromboembolism. 27 …”

Evaluation of donor workups and exclusions in a single‐center experience of living donor liver transplantation

“…Furthermore, the imbalance of a coagulation profile might occur shortly after hepatectomy, even in a patient with a normal preoperative coagulation profile. The best clinical practice for the time being is a full investigation for the possibility of inherited coagulation disorders, followed by careful monitoring of the postoperative coagulation profile both in donors and recipients . The routine use of elastic stockings, early postoperative ambulation, and careful consideration of central venous line placement in the borderline coagulation profile group are also beneficial …”