Reuters Health Information (2005-10-04): Most liver donors do well postoperatively
Most liver donors do well postoperatively
Last Updated: 2005-10-04 13:33:31 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Although there may be
morbidity following live liver donation, most procedures are
uncomplicated or do not lead to permanent consequences in the donors,
researchers report in the September issue of the Archives of Surgery.
However, Dr. Christopher R. Shackleton of the David Geffen School of
Medicine at UCLA, Los Angeles and colleagues note that the true extent
of morbidity among live liver donors remains poorly understood.
One shortcoming is "the absence of accepted standards of what
constitutes a complication together with an objective framework with
which to classify and report them," he told Reuters Health.
"While these considerations clearly have relevance to all forms of
surgery," he added, "they are all the more germane when considering a
very major operation which confers no direct health benefit to the
individual undergoing it."
To gain further insight, the researchers prospectively reviewed
adverse events associated with liver transplantation at their
Of the 202 people who underwent evaluation for live liver donation,
42 (20.8%) went on to surgery. Of these, 34 underwent a right lobectomy
without the middle hepatic vein and 3 had a left lateral segmentectomy.
In the remaining 5 donors, the hepatectomy was aborted for anatomical
reasons before parenchymal transection.
There were no deaths or significant hepatic dysfunction. However, 8
(22%) of the 37 donors experienced a total of 11 adverse events. These
included an iatrogenic narcotic overdose, bile leaks and wound
Ten adverse events were seen within 1 month postoperatively and all
but one -- brachial plexopathy -- resolved without permanent disability.
The overall incidence of adverse events of 0.3 per case is
relatively low and most resolve without permanent sequelae, the
researchers note. Nevertheless, the risk of sustained disease or
disability ranges from 3% to 10%.
The team calls for better reporting and classification of adverse
events and conclude that, "albeit low, the risk of death or need for
transplantation is real."
As Dr. Shackleton pointed out, the successful development and
application of liver transplantation, "represents a technical
tour-de-force for the international transplant community. However, it
remains a procedure in evolution and our enthusiasm to aid the sick
must not overshadow the safety of the donor."
Arch Surg 2005;140:888-895.