Clinical

Most liver donors do well postoperatively

Last Updated: 2005-10-04 13:33:31 -0400 (Reuters Health)

By David Douglas

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 institution.

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 infection.

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.