The safety of the donor operation in living-donor liver transplantation: an analysis of 45 donors

Abstract

We retrospectively assessed the safety of the donor operation, based on parameters such as blood loss, blood transfusion, operation time, duration of hospitalization, and complications. Forty-five pediatric and adult recipients underwent living-donor liver transplantation (LDLTx) in Tohoku University Hospital from July 1991 to October 2000. Donor operations were classified into three groups. In the LS group, the graft was the lateral segment (n=20); in the LL group, the graft was the left lobe without the middle hepatic vein (n= 16); and in the LLM group, the graft was the left lobe with the middle hepatic vein (n = 9). No significant differences were observed among the three groups regarding postoperative liver function or duration of hospitalization. In the LS group, the operation time was shorter and the requirement of autologous blood transfusion was significantly lower than in the other two groups. Most complications following retrieval of the graft were minor. Safety is guaranteed when the left lobe or the left lateral segment is used for LDLTx, but meticulous management of the operation is required to prevent complications.

Differences of perioperative liver function, transfusion, and complications according to the type of hepatectomy in living donors

“…Other studies have reported different findings from our results on postoperative LFT, blood loss and transfusion, and duration of hospital stay according to the type of donor hepatectomy [8–11]. Sugawara et al [10] reported that although the longest surgical time and the greatest blood loss were observed in LL compared with LSS and RL, duration of postoperative hospital stay and blood transfusion units showed no differences among the three groups.…”

When is it safe for the liver donor to be discharged home and prevent unnecessary re‐hospitalizations? – A systematic review of the literature and expert panel recommendations

“…Considering the second critical outcome, the liver dysfunction tests were reported in 13 studies, 18 , 23 – 25 , 33 , 44 , 52 , 58 , 67 , 69 , 71 – 73 50–50 criteria 76 were used only in two studies 20 , 24 . The bilirubin and INR (the perioperative peak and at 5 days) values were significantly lower ( p < .001) in patients undergoing left lobe compared to patients with right lobe hepatectomy 68 .…”

“…Fourteen studies 19 , 22 , 24 , 25 , 27 , 30 , 38 , 40 , 42 , 43 , 45 , 47 , 52 were European, 11 23 , 24 , 29 , 32 , 37 , 41 , 53 , 56 , 57 , 63 , 66 American (North and south), 28 20 , 21 , 24 , 26 , 28 , 31 , 33 , 34 – 36 , 44 , 46 , 48 – 51 , 54 , 55 , 60 , 62 , 64 , 65 , 67 – 69 , 71 – 73 were Asian‐Pacific, and 5 18 , 39 , 58 , 59 , 70 were African. Of the studies selected, 29 were published before 2011, 18 , 19 , 21 , 22 , 26 , 27 , 29 – 32 , 34 , 38 – 42 , 48 – 51 , 53 – 55 , 57 ,...…”

“…Among 57 studies, 7 21 , 29 , 37 , 38 , 44 , 54 , 56 and 37 22 , 27 – 31 , 35 – 51 , 53 , 54 , 56 , 57 , 61 – 67 , 69 , 70 studies provide data on complicationsrate and on bilirubin or prothrombin time/INR peak or level, respectively.…”

“…Some 103 full‐text articles were excluded for the following reason: recipients only ( n = 21); not relevant ( n = 55); opinion ( n = 10); case study ( n = 1); pediatric LD ( n = 7); not English ( n = 2); systematic/Lit review ( n = 4); published abstract ( n = 3); duplicates (= 1). In qualitative synthesis, 57 studies were included 18–73 . Studies with less than 50 patients and published more than 10 years ( n = 28) were also excluded of the GRADE.…”