Morbidity in live liver donors: standards-based adverse event reporting further refined.
OBJECTIVE
The true extent of morbidity among live liver donors remains poorly understood. In this unique and often high-profile area of surgery, the development of standards for defining and reporting complications would foster a better understanding of the incidence and magnitude of such adverse events (AEs).


METHODS
Retrospective review of AEs among live liver donors.


METHODS
University-affiliated teaching hospital.


METHODS
Of 202 individuals undergoing evaluation for live liver donation, 42 (20.8%) proceeded to surgery. Thirty-four underwent a right lobectomy without the middle hepatic vein; 3, a left lateral segmentectomy. Any event causing a deviation from a patient's ideal course was considered an AE and subsequently classified according to a derived framework. Morbidity was defined as 1 or more AEs.


METHODS
Incidence, timing, type, severity, and impact of AEs.


RESULTS
No deaths or significant hepatic dysfunction occurred. In 5 (12%) of the 42 donors, the hepatectomy was aborted for anatomic reasons before parenchymal transection. Eight (22%) of the remaining 37 experienced 11 AEs, of which 10 completely resolved, whereas 1 AE (3%) resulted in a permanent disability (brachial plexopathy). The overall incidence of AEs was 0.30 per case. Ten (91%) of the 11 AEs presented within the first postoperative month.


CONCLUSIONS
Most live liver donations are uncomplicated or do not lead to permanent consequence. The adoption of a standards-based classification framework for AEs in live liver donors would allow for an inclusive, consistent, and universally applicable method to collect, analyze, and report donor morbidity.
Shackleton
Christopher R
CR
Center for Liver Diseases and Transplantation, Cedars-Sinai Medical Center, and Department of Surgery, The David Geffen School of Medicine at UCLA, USA. shackletonc@thelivercenter.org
Vierling
John M
JM
Nissen
Nicholas
N
Martin
Paul
P
Poordad
Fred
F
Tran
Tram
T
Colquhoun
Steven D
SD
D000328:Adult; D005260:Female; D006498:Hepatectomy; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012308:Risk Management / Q000592:standards*