Liver-transplant donors have few complications, good outcomes

Last Updated: 2018-04-11

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - People who donate part of their liver for transplantation have few complications, whether in the short or long term, and can lead normal healthy lives, a new single-center study suggests.

With liver transplant being the only definitive treatment for end-stage liver disease and not enough deceased donors available, living donor liver transplantation has become increasingly important.

"Living liver donation is one of the most selfless acts a person can perform. This single-center study documenting the safety of liver donation in United States adds information that clinicians can share with their potential donors and patients," said senior author Dr. Srinath Chinnakotla of the University of Minnesota in Minneapolis.

"These data can reassure donors that not only the early complications but the long-term outcomes are good," he told Reuters Health by email. "Hepatologists should be more aggressive in promoting living liver donation."

Dr. Chinnakotla and his colleagues retrospectively analyzed outcomes of 176 living liver donors at one transplant center to determine the incidence, type and Clavien grade of complications, as well as the donors' long-term quality of life.

Nearly 90% of the donors underwent right hepatectomy; four had left-hepatectomy lobectomy; and 18 had left lateral segmentectomy. The mean follow-up time was 4.8 years.

Early complication rates were comparable to those of earlier multicenter reports. Of right-lobe donors, 41% had post-operative complications, compared to 18% of left-lobe donors (P=0.003).

Most complications (82%) were Clavien grade 1 or 2. The incidence of Clavien grade 3 complications was less than 8% and primarily involved technical bile leaks and intra-abdominal bleeding. No donor had Clavien grade 4 or higher complications.

On multivariable regression, resected graft volume and post-donation international normalized ratio (INR) above 2 were significantly linked with higher risk of Clavien grade 3 complications. But age, gender, prior abdominal surgery, post-donation bilirubin over 6 mg/dL and aspartate transaminase over 650 IU/L were not.

In 36-item Short-Form Health Surveys (SF-36) the donors completed an average of almost five years after their donation, they reported above-average quality of life compared with the population of the United States. In a liver-donation survey they completed between one and 15 years after donation, they reported their most frequent problems to be incisional discomfort and fatty meal intolerance.

The authors acknowledge that the retrospective study design, changes in surgical technique and post-surgical pain management and the small number of donors over the 19-year period, were their study's limitations.

Dr. John Seal, an abdominal transplantation and hepatobiliary surgeon at Ochsner Multi-Organ Transplant Institute in New Orleans, Louisiana, told Reuters Health by email, "This single-center study corroborates with greater detail the findings of the A2ALL study demonstrating, most importantly, the overall safety of living donation for liver transplantation. Less than 10% of donors had complications that required intervention and none of the reported complications were life-threatening."

"While it is important to acknowledge the possibility of adverse events, as a transplant community we must calibrate our understanding of the risks associated with living donation based on institutional and multi-center reports like this," added Dr. Seal, who was not involved in the study. "There is a need for greater transparency and sharing of best practices between living-donor-liver-transplant centers so all can benefit from improved safety for living donors."

Dr. Seal noted that these results are consistent with other reports and are an important contribution to current knowledge about the safety of living-donor liver transplantation.

"I would be cautious with the interpretation of the lower rates of complications in the donors who had a left hepatectomy," he advised. "For most of the analysis, left lateral segment hepatectomy was grouped with full left-lobe donation, but these are technically very different operations. Overall, left lateral segments are typically used for pediatric recipients, confer a lower risk to the donor overall, and should probably be considered separately with respect to understanding the risks associated with living donation."

SOURCE: https://bit.ly/2JDdCx0

J Am Coll Surg 2018.