78 percent of living right liver donors experienced post-operative complications

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78 percent of living right liver donors experienced post-operative

complications

Published: Thursday, 7-Jun-2007

More than 78 percent of living right liver donors experienced post-

operative complications, according to a new study that uses a

replicable complication classification system. Most of the

complications were minor, though some were more serious.

The full findings are published in Liver Transplantation, a journal

by Wiley & Sons. The article is also available online via Wiley

Interscience.

The demand for donor livers far outstrips the supply from deceased

donors, so living donor liver transplantation has become increasingly

common ever since it was first reported successful in 1989. While a

donor left hepatectomy is associated with fewer complications than a

right hepatectomy, often the right liver is needed to meet the

metabolic demands of large recipients. Complication rates from right

hepatectomy have been reported to range between 0 percent and 67

percent, depending on the definition of morbidity.

In an effort to pinpoint the true complication rate for living right

liver donors, researchers led by Kyung-Suk Suh of Seoul National

University College of Medicine, prospectively analyzed the outcomes

of 83 consecutive living donor right hepatectomies using a

standardized classification of the severity of complications. They

used a modified Clavien system: Grade I=minor complications; Grade

II=potentially life-threatening complications requiring pharmacologic

treatment; Grade III=complications requiring invasive treatment;

Grade IV=complications causing organ dysfunction requiring ICU

management; Grade V=complications resulting in death. (Please note

that the original classification of postoperative complication was

suggested by Clavien et al and Broering et al.)

The study took place between January 2002 and July 2004 at the Seoul

National University Hospital and the donors, usually offspring of the

recipients, underwent either right hepatectomy or a modified extended

right hepatectomy. The researchers monitored them for complications

for 12-months after their surgery.

There were no significant differences in the types and incidences of

complications between the donors who underwent right hepatectomy and

those who underwent modified extended right hepatectomy Overall, 65

of the 83 donors (78.3 percent) experienced complications. " Most were

minor and self-limited or were silent in that they were only noted in

laboratory and protocol imaging studies, " the authors

report. " However, several patients experienced potentially life-

threatening complications requiring additional treatment. "

Sixty-four patients (77.1 percent) had Grade 1 complications, most

commonly hyperbilirubinemia and pleural effusion. Eleven donors had

Grade II complications, mostly bile leakage. One donor had a Grade

III complication. And no donors had Grade IV or IV complications. At

the one-year follow-up, 93 percent of donors had normal bilirubin and

ALT levels.

" In conclusion, although most of these adverse events were minor and

self-limited, 78 percent of right liver donors still experienced

morbidity, " the authors report. " Therefore, continuous standardized

reporting of the donor morbidity as well as meticulous surgery and

intensive care is essential for the success of donor right

hepatectomy implementation. "

An accompanying editorial by Yasuhiko Sugawara et al. of the

University of Tokyo praised the effort to introduce a standardized

assessment system to evaluate the rate of complications for living

liver donors. " The modified Clavien's classification system

introduced in 2004 is simple and informative. We believe its use will

greatly enhance the comparison of living donor liver transplantation

outcomes, " the authors write. " From now on, the modified Clavien's

classification system should be used whenever surgical complications

of live liver donors are discussed. "

http://www.interscience.wiley.com/journal/livertransplantation