Donor safety in living related liver transplantation: underestimation of the risks for deep vein thrombosis and pulmonary embolism.
Optimal safety for donors is a necessary condition for living related liver transplantation to expand. Although the risks for complications directly related to surgical intervention have been carefully evaluated, the extent and nature of other complications, such as pulmonary embolism, associated with living donation have not been clearly anticipated. We report a case of severe pulmonary embolism followed by ulcer-related upper digestive tract bleeding in an adult donor after right hepatectomy. In this donor, we found an unexpected predisposing coagulation disorder (increased von Willebrand factor activity) postoperatively. This finding led us to include systematic screening for coagulation disorders during evaluation of donors, a policy which led us thereafter to reject definitely or temporarily some candidates for donation. Although the cost-effectiveness of such investigations is not definitely established, we strongly recommend a specific approach to improve donor safety. In addition, we emphasize that the major complications observed in living donors should be systematically reported in an international database.
Durand
François
F
Department of Hepatology and Institut National de la Santé Et de la Recherche Médicale (INSERM) U481, Clichy, France.
Ettorre
Giuseppe Maria
GM
Douard
Richard
R
Denninger
Marie-Hélène
MH
Kianmanesh
Alireza
A
Sommacale
Daniele
D
Farges
Olivier
O
Valla
Dominique
D
Belghiti
Jacques
J
D000328:Adult; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000209:etiology*; D012307:Risk Factors; D012449:Safety; D020246:Venous Thrombosis / Q000209:etiology*