Donor morbidity after living donation for liver transplantation.
OBJECTIVE
Reports of complications among adult right hepatic lobe donors have been limited to single centers. The rate and severity of complications in living donors were investigated in the 9-center Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL).


METHODS
A retrospective observational study design was used. Participants included all potential living donors evaluated between 1998 and 2003. Complication severity was graded using the Clavien scoring system.


RESULTS
Of 405 donors accepted for donation, 393 underwent donation, and 12 procedures were aborted. There were 245 donors (62%) who did not experience complications; 82 (21%) had 1 complication, and 66 (17%) had 2 or more. Complications were scored as grade 1 (minor; n = 106, 27%), grade 2 (potentially life threatening; n = 103, 26%), grade 3 (life threatening; n = 8, 2%), and grade 4 (leading to death; n = 3, 0.8%). Common complications included biliary leaks beyond postoperative day 7 (n = 36, 9%), bacterial infections (n = 49, 12%), incisional hernia (n = 22, 6%), pleural effusion requiring intervention (n = 21, 5%), neuropraxia (n = 16, 4%), reexploration (n = 12, 3%), wound infections (n = 12, 3%), and intraabdominal abscess (n = 9, 2%). Two donors developed portal vein thrombosis, and 1 had inferior vena caval thrombosis. Fifty-one (13%) donors required hospital readmission, and 14 (4%) required 2 to 5 readmissions.


CONCLUSIONS
Adult living liver donation was associated with significant donor complications. Although most complications were of low-grade severity, a significant proportion were severe or life threatening. Quantification of complication risk may improve the informed consent process, perioperative planning, and donor care.
Ghobrial
Rafik M
RM
Department of Surgery, University of California Los Angeles, Los Angeles, California, USA. a2all-dcc@umich.edu
Freise
Chris E
CE
Trotter
James F
JF
Tong
Lan
L
Ojo
Akinlolu O
AO
Fair
Jeffrey H
JH
Fisher
Robert A
RA
Emond
Jean C
JC
Koffron
Alan J
AJ
Pruett
Timothy L
TL
Olthoff
Kim M
KM
D000328:Adult; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007258:Informed Consent; D007431:Intraoperative Complications / Q000453:epidemiology; D007902:Length of Stay; D016031:Liver Transplantation / Q000706:statistics & numerical data; D019520:Living Donors / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010353:Patient Education as Topic; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States