Right-lobe liver transplant from donors with Gilbert syndrome.
OBJECTIVE
Donor safety is one of the most important aspects of living-donor liver transplant. The preoperative evaluation of candidates for such transplants essentially starts with serologic and biochemical analyses. However, some potential liver donors with normal liver function test results may have isolated mild hyperbilirubinemia (serum indirect bilirubin level > 20.5 μmol/L [1.2 mg/dL]). Gilbert syndrome is an autosomal recessive condition that is a common cause of nonhemolytic unconjugated hyperbilirubinemia, and its prevalence is 3% to 10% in the healthy US population. Mild hyperbilirubinemia episodes are expected in people with Gilbert syndrome when they are exposed to physical stress, such as operative intervention or low energy intake. The liver morphologic findings of these individuals are normal; however, there is a debate on the use of people with Gilbert syndrome as living-liver donors. The purpose of this study was to assess the results of right-lobe living-donor hepatectomy of liver donors with Gilbert syndrome.


METHODS
Between 2004 and 2010, two hundred twenty-five living-donor liver transplants using right-lobe grafts were performed in our hospital. Donors with Gilbert syndrome were defined as those whose serum bilirubin level was greater than 20.5 μmol/L (1.2 mg/dL). Six of 225 right-lobe living-donor liver transplants were performed using donors with Gilbert syndrome.


RESULTS
The median follow-up after transplant was 34 months (range, 18 to 51 mo). One week after the operation, the median bilirubin level for right-lobe liver donors was 34.5 μmol/L (2.02 mg/dL) (range, 17.1 to 51.3 μmol/L [1 to 3 mg/dL]), and the median prothrombin time (international normalized ratio) was 1.36 (range, 1.1 to 1.7). The median bilirubin level of the donors after 6 months was 29 μmol/L (1.7 mg/dL) (range, 20.5 to 41 μmol/L [1.2 to 2.4 mg/dL]).


CONCLUSIONS
Living-donor liver transplant from Gilbert syndrome donors can be safely performed.
Sisli Florence Nightingale Hospital, Department of General Surgery and Organ Transplantation, Sisli, Istanbul, Turkey. tolgademirbas@yahoo.com
Tolga
T
Demirbas
Turgut
T
Piskin
Murat
M
Dayangac
Onur
O
Yaprak
Murat
M
Akyildiz
Yaman
Y
Tokat
Yildiray
Y
Yuzer
D000293:Adolescent; D000328:Adult; D001663:Bilirubin / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005878:Gilbert Disease / Q000097:blood / Q000150:complications*; D006085:Graft Survival / Q000502:physiology; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood / Q000209:etiology*; D008099:Liver / Q000601:surgery*; D017093:Liver Failure / Q000601:surgery; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000502:physiology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D061214:Patient Safety; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D001663:Bilirubin