title: Live donor hepatectomy for liver transplantation in Egypt: Lessons learned.
abstract: OBJECTIVE
  To retrospectively review anesthesia and intensive care management of 145 consented volunteers subjected to right lobe or left hepatectomy between 2003 and 2011.
  
  
  METHODS
  After local ethics committee approval, anesthetic and intensive care charts, blood transfusion requirements, laboratory data, complications and outcome of donors were analyzed.
  
  
  RESULTS
  One hundred and forty-three volunteers successfully tolerated the surgery with no blood transfusion requirements, but with a morbidity rate of (50.1%). The most frequent complication was infection (21.1%) (intraabdominal collections), followed by biliary leak (18.2%). Two donors had major complications: one had portal vein thrombosis (PVT) treated with vascular stent. This patient recovered fully. The other donor had serious intraoperative bleeding and developed postoperative PVT and liver and renal failure. He died after 12 days despite intensive treatment. He was later reported among a series of fatalities from other centers worldwide. Epidural analgesia was delivered safely (n=90) with no epidural hematoma despite significantly elevated prothrombin time (PT) and international normalization ratio (INR) postoperatively, reaching the maximum on Day 1 (16.9±2.5 s and 1.4±0.2, P<0.05 when compared with baseline). Hypophosphatemia and hypomagnesemia were frequently encountered. Total Mg and phosphorus blood levels declined significantly to 1.05±0.18 mg/dL on Day 1 and 2.3±0.83 mg/dL on Day 3 postoperatively.
  
  
  CONCLUSIONS
  Coagulation and electrolytes need to be monitored perioperatively and replaced adequately. PT and INR monitoring postoperatively is still necessary for best timing of epidural catheter removal. Live donor hepatectomy could be performed without blood transfusion. Bile leak and associated infection of abdominal collections requires further effort to better identify biliary leaks and modify the surgical closure of the bile ducts. Donor hepatectomy is definitely not a complication-free procedure; reported complication risks should be available to the volunteers during consenting.
authors.affiliation: Department of Anaesthesia, National Liver Institute, Menoufiya University, Shebeen El-Kom, Menoufiya, Egypt.
authors.forename: Emad
authors.initials: E
authors.lastname: Kamel
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdullah
authors.forename: Ashraf
authors.initials: A
authors.lastname: Hassanin
authors.forename: Nirmeen
authors.initials: N
authors.lastname: Fayed
authors.forename: Fatma
authors.initials: F
authors.lastname: Ahmed
authors.forename: Hossam
authors.initials: H
authors.lastname: Soliman
authors.forename: Osama
authors.initials: O
authors.lastname: Hegazi
authors.forename: Yasmine Abd
authors.initials: YA
authors.lastname: El Salam
authors.forename: Magdy
authors.initials: M
authors.lastname: Khalil
authors.forename: Khaled
authors.initials: K
authors.lastname: Yassen
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Marwan
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
authors.forename: Khaled
authors.initials: K
authors.lastname: Aboella
authors.forename: Tarek
authors.initials: T
authors.lastname: Ibrahim