Complications after Living Donor Hepatectomy: Analysis of 176 Cases at a Single Center

Danielle Berglund; Varvara Kirchner; Timothy Pruett; Saumya Mangalick; Raja Kandaswamy; Oscar K Serrano; Bradley Benson; Steven Mongin; John Lake; Srinath Chinnakotla

doi:10.1016/j.jamcollsurg.2018.03.007

Complications after Living Donor Hepatectomy: Analysis of 176 Cases at a Single Center

J Am Coll Surg. 2018 Jul;227(1):24-36. doi: 10.1016/j.jamcollsurg.2018.03.007. Epub 2018 Mar 17.

Authors

Affiliations

¹ Informatics Services for Research and Reporting, Fairview Health Services, Minneapolis, MN.
² Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN.
³ University of Minnesota, Minneapolis, MN.
⁴ Department of Medicine, University of Minnesota Medical School, Minneapolis, MN.
⁵ Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, MN.
⁶ Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN. Electronic address: chinni@umn.edu.

PMID: 29555562
DOI: 10.1016/j.jamcollsurg.2018.03.007

Abstract

Background: Living liver donation is one of the most selfless and humane acts a person can perform. Few single-center reports have been published specifically evaluating complications and quality of life post-donation.

Study design: We conducted a retrospective analysis of outcomes of 176 living liver donors at our center to determine the incidence, type, and Clavien grade of complications, as well as long-term quality of life.

Results: Of 176 living donors, 154 underwent right hepatectomy, 4 underwent left hepatectomy lobectomy, and 18 underwent left lateral segmentectomy. Mean follow-up time was 4.8 years. Complications were more frequent among right-lobe donors than left-lateral segmentectomy and left-lobe donors (p = 0.003). Of note, 82% of complications were Clavien grade 1 or 2. Of the 154 right-lobe donors, 3 had Clavien grade 3a complications, 9 had grade 3b complications (4 had bile leaks, 3 had intra-abdominal bleeding, and 2 had pleural effusions). No donor had complications that were Clavien grade 4 or higher. Per multivariate regression, resected graft volume (p = 0.0498) and post-donation international normalized ratio >2 (p = 0.00499) were significantly associated with a higher risk of Clavien grade 3 complications; however, sex, age, previous abdominal operation, post-donation bilirubin >6 mg/dL, and aspartate transaminase >650 IU/L were not. Per our 36-item Short-Form Health Survey results, donors (mean 8.3 years post-donation) reported above-average quality of life compared with standard US population. In a liver donation survey sent between 1 and 15 years post-donation, the most frequently reported problems were incisional discomfort and intolerance to fatty meals.

Conclusions: In our single-center study, early complication rates were comparable with those of multicenter reports. Most complications (82%) were Clavien grade 1 or 2. During a long follow-up period, our donors continue to have improved quality of life.

MeSH terms

Adult
Female
Follow-Up Studies
Hepatectomy / methods*
Humans
Liver Function Tests
Liver Transplantation*
Living Donors*
Male
Middle Aged
Postoperative Complications / classification*
Quality of Life*
Retrospective Studies
Risk Factors