Living donor liver transplantation: complications in donors and interventional management

To evaluate the incidence of postoperative complications in liver donors and the efficacy of interventional management for treating these complications.

The study included 386 consecutive donors: 219 donors underwent right lobectomy or segmentectomy and 167 donors underwent left lobectomy or segmentectomy. Postoperative status, laboratory data, and radiologic images were reviewed for postoperative complications. Interventional management consisted of percutaneous drainage, ultrasonographic (US)-guided aspiration, percutaneous transhepatic biliary drainage (PTBD) and balloon dilation, transcatheter arterial embolization, or portal vein stent placement. Technical success, clinical improvement, and complications were documented following intervention.

In 52 (13.5%) donors, 56 postoperative complications were encountered, including pleural effusion (n = 9), biliary leakage (n = 6), biliary obstruction (n = 5), intraperitoneal abscess (n = 5), active bleeding (n = 5), portal vein stenosis or kink (n = 3), biloma (n = 2), and other complications (n = 21). Complications occurred in 41 (18.9%) right lobe and 11 (7.0%) left lobe donors (P <.001). Twenty-seven (48%) complications were treated with interventional management (percutaneous drainage, n = 10; US-guided aspiration, n = 6; PTBD and balloon dilation, n = 4; transcatheter arterial embolization, n = 4; and stent placement, n = 3) and resolved completely. No procedure-related complications occurred. In one donor with venous oozing, arteriographic images did not show an active bleeding focus; thus, bleeding control with interventional management failed. The remaining 29 complications were treated using medical (n = 27) or surgical (n = 2) management. One donor with acute renal failure has thus far been treated with hemodialysis.

Although complications from liver donation are not uncommon, most are minor and, with medical or interventional management, have no long-term sequelae. Interventional management seems useful in the treatment of postoperative complications of liver donation.