Improving Safety in Living Liver Donation: Lessons From Intraoperative Adverse Events in 438 Donors Undergoing a Left...

Area of Science:

• Hepatobiliary Surgery
• Transplantation Surgery
• Surgical Safety

Background:

• Donor safety is paramount in living organ donation.
• Left liver resections are generally safer than right lobe resections.
• Unexpected intraoperative adverse events (iAEs) can occur, posing risks to donors and recipients.

Purpose of the Study:

• To analyze intraoperative adverse events (iAEs) in living liver donors (LDs) undergoing left liver resections.
• To identify the causes and impact of iAEs on donor and recipient outcomes.
• To assess the role of iAE analysis in improving surgical protocols and donor safety.

Main Methods:

• Retrospective review of 438 LDs undergoing left lateral sectionectomies (LLSs) or left hepatectomies (LHs) from 1993-2018.
• Identification and classification of iAEs based on their impact on donor/recipient outcomes.
• Comparison of clinical characteristics and postoperative complications between LLS and LH groups.

Main Results:

• Nine iAEs (2% incidence) occurred, exclusively in the LLS group, mostly related to surgical maneuvers (vascular and biliary).
• Donor outcome was at risk in 5 iAEs, recipient outcome in 2, and both in 2.
• Postoperative complications occurred in 19.9% of LDs, with no significant difference between LLS and LH groups; no major complications or mortality were observed.

Conclusions:

• Debriefing and analysis of iAEs led to protocol changes, potentially reducing morbidity and achieving zero mortality.
• iAE analysis serves as a valuable quality and safety improvement tool for living donor procedures.
• This approach can enhance safety in various living liver donation settings, including right lobe, laparoscopic, and robotic procurements.