title: Incidence of death and potentially life-threatening near-miss events in living donor hepatic lobectomy: a world-wide survey.
abstract: The incidence of morbidity and mortality after living donor liver transplantation (LDLT) is not well understood because reporting is not standardized and relies on single-center reports. Aborted hepatectomies (AHs) and potentially life-threatening near-miss events (during which a donor's life may be in danger but after which there are no long-term sequelae) are rarely reported. We conducted a worldwide survey of programs performing LDLT to determine the incidence of these events. A survey instrument was sent to 148 programs performing LDLT. The programs were asked to provide donor demographics, case volumes, and information about graft types, operative morbidity and mortality, near-miss events, and AHs. Seventy-one programs (48%), which performed donor hepatectomy 11,553 times and represented 21 countries, completed the survey. The average donor morbidity rate was 24%, with 5 donors (0.04%) requiring transplantation. The donor mortality rate was 0.2% (23/11,553), with the majority of deaths occurring within 60 days, and all but 4 deaths were related to the donation surgery. The incidences of near-miss events and AH were 1.1% and 1.2%, respectively. Program experience did not affect the incidence of donor morbidity or mortality, but near-miss events and AH were more likely in low-volume programs (≤50 LDLT procedures). In conclusion, it appears that independently of program experience, there is a consistent donor mortality rate of 0.2% associated with LDLT donor procedures, yet increased experience is associated with lower rates of AH and near-miss events. Potentially life-threatening near-miss events and AH are underappreciated complications that must be discussed as part of the informed consent process with any potential living liver donor.
authors.affiliation: Department of Transplantation and Hepatobiliary Diseases, Lahey Clinic Medical Center, Tufts Medical School, Burlington, MA, USA.
authors.forename: Yee Lee
authors.initials: YL
authors.lastname: Cheah
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Simpson
authors.forename: James J
authors.initials: JJ
authors.lastname: Pomposelli
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Pomfret
mesh_terms: D002423:Cause of Death; D003625:Data Collection; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D019520:Living Donors; D009017:Morbidity; D020858:Tissue and Organ Harvesting / Q000401:mortality*