Life-threatening or nearly life-threatening complications in living liver donors

Area of Science:

• Hepatobiliary Surgery
• Transplant Surgery
• Surgical Outcomes Research

Background:

• Living donor hepatectomy (LDH) is a complex procedure with inherent risks.
• Assessing factors influencing donor safety is crucial for ethical and effective living donation programs.
• Transplant center experience is a potential modifiable factor impacting complication rates.

Purpose of the Study:

• To investigate the association between a transplant center's cumulative experience and the occurrence of severe complications in living liver donors.
• To identify specific thresholds of center experience that may correlate with improved donor safety outcomes.

Main Methods:

• Retrospective analysis of medical records for 1140 patients undergoing LDH.
• Comparison of complication rates based on procedural volume (e.g., first 100 vs. subsequent cases) and time (e.g., first 5 years vs. subsequent 5 years).
• Statistical analysis to determine significant differences in life-threatening complications between patient cohorts.

Main Results:

• A total of 36 severe complications (2.98%) were recorded among 1140 donors, with biliary issues and bleeding being most common.
• No donor mortality was observed; one donor required deceased donor liver transplantation due to hepatic failure.
• Significantly lower rates of severe complications were observed when comparing the first 100 vs. subsequent 1040 LDHs (P=.03) and the first 200 vs. subsequent 940 LDHs (P=.01).

Conclusions:

• Increased transplant center experience, specifically exceeding 200 living donor hepatectomies, is associated with a reduction in severe complications.
• Establishing a high-volume center for LDH may enhance donor safety and improve surgical outcomes.
• Further research can explore specific procedural elements contributing to improved safety in experienced centers.