A prospective analysis of living-liver donation shows a high rate of adverse events.
Donor risk is the main obstacle in the development of living-donor liver transplantation in Western countries. The knowledge of a wide and uneven range of donor morbidity has come mainly from various retrospective analyses of complications in the literature. Donor outcomes have not been prospectively analyzed. From 1995, the intra- and postoperative courses of 127 living-donor hepatectomies were prospectively analyzed and recorded. All adverse events were classified and stratified according to the extent of surgery, including 45 left-lateral sectionectomies (LLS); 25 left hepatectomies (LH), and 57 right hepatectomies (RH). There was no donor death. The overall rate of significant complications was 20%, ranging from 8% after LH to 32% after RH. The overall incidences of surgical complications, reoperations, and hospital readmissions were 8%, 3%, and 5%, respectively. However, the prospective accumulation of all adverse events revealed an overall postoperative morbidity of 51%, ranging from 32% after LH to 66% after RH. In conclusion the incidence of postoperative adverse events after living donation is nearly 50% as revealed by prospective screening. These results allow more accurate information for potential donors. This study confirms that right hepatectomy carries three times higher risk of morbidity as compared to left-sided resections, leading to reappraisal of the use of left grafts in adults.
Department of Hepatobiliary Surgery, University Paris 7 Beaujon Hospital, 100 Bd du Général Leclerc, 92118 Clichy, France.
Federica
F
Dondero
Oliver
O
Farges
Jacques
J
Belghiti
Claire
C
Francoz
Daniele
D
Sommacale
Francois
F
Durand
Alain
A
Sauvanet
Sylvie
S
Janny
Deepak
D
Varma
Valerie
V
Vilgrain
D000328:Adult; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies