Living donor liver transplantation—Adult donor outcomes: A systematic review

Abstract

The objective of this study was to evaluate the safety and efficacy of adult-to-adult living donor liver transplantation, specifically donor outcomes. A systematic review, with searches of the literature up to January 2004, was undertaken. Two hundred and fourteen studies provided information on donor outcomes. The majority of these were case series studies, although there were also studies comparing living donor liver transplantation with deceased donor liver transplantation. Both underreporting and duplicate reporting is likely to have occurred, and so caution is required in interpretation of these results. Overall reported donor mortality was 12 to 13 in about 6,000 procedures (0.2%) (117 studies). Mortality for right lobe donors to adult recipients is estimated to be 2 to 8 out of 3,800 (0.23 to 0.5%). The donor morbidity rate ranged from 0% to 100% with a median of 16% (131 studies). Biliary complications and infections were the most commonly reported donor morbidities. Nearly all donors had returned to normal function by 3 to 6 months (18 studies). In conclusion, there are small, but real, risks for living liver donors. Due to the short history of adult-to-adult living donor liver transplantation, the long-term risks for donors are unknown. Liver Transpl 12: 24 -30, 2006.

Liver Transplantation for Hepatocellular Carcinoma in Asia

“…These hypothetical studies, however, neglected the risk to the living donor in the analysis. A systematic review of published data showed that the reported morbidity after donor hepatectomy varied widely from 0%-100%, with a median of 16% [47]. In Asia, donor morbidity was 15% from an international survey [48] and 12% from a multicenter study in Japan [49].…”

Role of Liver Transplantation for Hepatocellular Carcinoma

“…The mortality of liver donation has been reported to be about 0.2% (probably an underestimate since there is no registry in many countries which perform LDLT) and the morbidity has been estimated to be 0-100% depending on how it is measured. 21 It is also clear that as center experience grows, the incidence of serious complications decreases. 22 The risk to the donor would not be justifiable if there is little possibility of the recipient surviving long-term as when there is extrahepatic disease or gross vascular invasion.…”

Minors as Living Solid-Organ Donors

“…The calculated risk of mortality from kidney donation is approximately 2 in 10 000 24 and is up to 10-fold greater for a left lateral segment living liver donation (with the right-lobe having a greater risk than left-lobe). 25 There are also risks of significant morbidity, including postoperative bleeding and infections. All donors experience acute pain, and some develop chronic pain.…”

“…27 Other reviews have described the risk of morbidity as ranging from 0% to 100%. 25,28 The true rate of morbidity and mortality for other solid-organ donations is difficult to establish (eg, lung, pancreas, and small bowel) because of the small numbers of reported cases in the literature and the lack of living-donor registries. 29 Long-term risks for the potential child donor need to be considered as well, especially because there have been no long-term data on the safety of pediatric donation.…”