Respiratory complications: a major concern after right hepatectomy in living liver donors.
BACKGROUND
One of the main concerns after living donor liver transplantation is the risk of morbidity and/or mortality that it imposes on the donors. Respiratory postoperative complications in living liver donors have already been reported but their frequency seems to be underestimated. We designed a prospective study to evaluate the rate and the nature of postoperative pulmonary complications in 112 consecutive donors.


METHODS
The medical records of the 112 living liver donors operated on at our center from 1998 to 2003 were reviewed and all the cases of respiratory complications were retrieved. Moreover, since 2000, all patients had a computed tomography angiography of the thorax at day 7 on a prospective basis.


RESULTS
In all, 112 hepatectomies (44 right and 68 left) for adult-to-adult or adult-to-child liver donation were performed in our center. No postoperative mortality was recorded. Fourteen major respiratory complications developed in of 11 of 112 donors (9.8%), in all cases after right hepatectomy, and included nonsevere pulmonary embolism (n=7), right pleural empyema (n=3), and bacterial pneumonia (n=3). Minor respiratory complications (7.1% of the donors) included iatrogenic pneumothorax (n=3) and pleural effusion requiring thoracocentesis (n=5). Abdominal complications (mainly biliary leak) developed in 10 donors (8.9%), who in the vast majority remained free of pulmonary complications.


CONCLUSIONS
In our series, pulmonary complications are frequent in living liver donors. These complications are mainly observed after right hepatectomy. The particular prevalence of pulmonary embolism should lead to focus on its early diagnosis and prevention.
Dondero
Federica
F
Département de Pathologie Hépato-Biliaire, Hôpital Beaujon, Clichy, France.
Taillé
Camille
C
Mal
Hervé
H
Sommacale
Daniele
D
Sauvanet
Alain
A
Farges
Olivier
O
Francoz
Claire
C
Durand
François
F
Delefosse
Didier
D
Denninger
Marie Hélène
MH
Vilgrain
Valérie
V
Marrash-Chahla
Rolana
R
Fournier
Michel
M
Belghiti
Jacques
J
D000293:Adolescent; D000328:Adult; D002648:Child; D016724:Empyema, Pleural / Q000209:etiology; D005260:Female; D005602:France; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D011655:Pulmonary Embolism / Q000209:etiology; D012140:Respiratory Tract Diseases / Q000209:etiology* / Q000517:prevention & control