Donor Morbidity After Living Donation for Liver Transplantation

Rafik M. Ghobrial, Chris E. Freise, James F. Trotter, Lan Tong, Akinlolu O. Ojo, Jeffrey Fair, Robert A. Fisher, Jean C. Emond, Alan J. Koffron, Timothy L. Pruett, Kim M. Olthoff

Research output: Contribution to journalArticle

270 Citations (Scopus)

Abstract

Background & Aims: Reports of complications among adult right hepatic lobe donors have been limited to single centers. The rate and severity of complications in living donors were investigated in the 9-center Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL). Methods: A retrospective observational study design was used. Participants included all potential living donors evaluated between 1998 and 2003. Complication severity was graded using the Clavien scoring system. Results: Of 405 donors accepted for donation, 393 underwent donation, and 12 procedures were aborted. There were 245 donors (62%) who did not experience complications; 82 (21%) had 1 complication, and 66 (17%) had 2 or more. Complications were scored as grade 1 (minor; n = 106, 27%), grade 2 (potentially life threatening; n = 103, 26%), grade 3 (life threatening; n = 8, 2%), and grade 4 (leading to death; n = 3, 0.8%). Common complications included biliary leaks beyond postoperative day 7 (n = 36, 9%), bacterial infections (n = 49, 12%), incisional hernia (n = 22, 6%), pleural effusion requiring intervention (n = 21, 5%), neuropraxia (n = 16, 4%), reexploration (n = 12, 3%), wound infections (n = 12, 3%), and intraabdominal abscess (n = 9, 2%). Two donors developed portal vein thrombosis, and 1 had inferior vena caval thrombosis. Fifty-one (13%) donors required hospital readmission, and 14 (4%) required 2 to 5 readmissions. Conclusions: Adult living liver donation was associated with significant donor complications. Although most complications were of low-grade severity, a significant proportion were severe or life threatening. Quantification of complication risk may improve the informed consent process, perioperative planning, and donor care.

Original languageEnglish (US)
Pages (from-to)468-476
Number of pages9
JournalGastroenterology
Volume135
Issue number2
DOIs
StatePublished - Aug 2008
Externally publishedYes

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Liver Transplantation
Tissue Donors
Morbidity
Living Donors
Thrombosis
Patient Readmission
Venae Cavae
Liver
Wound Infection
Pleural Effusion
Portal Vein
Informed Consent
Bacterial Infections
Abscess
Observational Studies
Cohort Studies
Retrospective Studies

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Ghobrial, R. M., Freise, C. E., Trotter, J. F., Tong, L., Ojo, A. O., Fair, J., ... Olthoff, K. M. (2008). Donor Morbidity After Living Donation for Liver Transplantation. Gastroenterology, 135(2), 468-476. https://doi.org/10.1053/j.gastro.2008.04.018

Donor Morbidity After Living Donation for Liver Transplantation. / Ghobrial, Rafik M.; Freise, Chris E.; Trotter, James F.; Tong, Lan; Ojo, Akinlolu O.; Fair, Jeffrey; Fisher, Robert A.; Emond, Jean C.; Koffron, Alan J.; Pruett, Timothy L.; Olthoff, Kim M.

In: Gastroenterology, Vol. 135, No. 2, 08.2008, p. 468-476.

Research output: Contribution to journalArticle

Ghobrial, RM, Freise, CE, Trotter, JF, Tong, L, Ojo, AO, Fair, J, Fisher, RA, Emond, JC, Koffron, AJ, Pruett, TL & Olthoff, KM 2008, 'Donor Morbidity After Living Donation for Liver Transplantation', Gastroenterology, vol. 135, no. 2, pp. 468-476. https://doi.org/10.1053/j.gastro.2008.04.018
Ghobrial, Rafik M. ; Freise, Chris E. ; Trotter, James F. ; Tong, Lan ; Ojo, Akinlolu O. ; Fair, Jeffrey ; Fisher, Robert A. ; Emond, Jean C. ; Koffron, Alan J. ; Pruett, Timothy L. ; Olthoff, Kim M. / Donor Morbidity After Living Donation for Liver Transplantation. In: Gastroenterology. 2008 ; Vol. 135, No. 2. pp. 468-476.
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title = "Donor Morbidity After Living Donation for Liver Transplantation",
abstract = "Background & Aims: Reports of complications among adult right hepatic lobe donors have been limited to single centers. The rate and severity of complications in living donors were investigated in the 9-center Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL). Methods: A retrospective observational study design was used. Participants included all potential living donors evaluated between 1998 and 2003. Complication severity was graded using the Clavien scoring system. Results: Of 405 donors accepted for donation, 393 underwent donation, and 12 procedures were aborted. There were 245 donors (62{\%}) who did not experience complications; 82 (21{\%}) had 1 complication, and 66 (17{\%}) had 2 or more. Complications were scored as grade 1 (minor; n = 106, 27{\%}), grade 2 (potentially life threatening; n = 103, 26{\%}), grade 3 (life threatening; n = 8, 2{\%}), and grade 4 (leading to death; n = 3, 0.8{\%}). Common complications included biliary leaks beyond postoperative day 7 (n = 36, 9{\%}), bacterial infections (n = 49, 12{\%}), incisional hernia (n = 22, 6{\%}), pleural effusion requiring intervention (n = 21, 5{\%}), neuropraxia (n = 16, 4{\%}), reexploration (n = 12, 3{\%}), wound infections (n = 12, 3{\%}), and intraabdominal abscess (n = 9, 2{\%}). Two donors developed portal vein thrombosis, and 1 had inferior vena caval thrombosis. Fifty-one (13{\%}) donors required hospital readmission, and 14 (4{\%}) required 2 to 5 readmissions. Conclusions: Adult living liver donation was associated with significant donor complications. Although most complications were of low-grade severity, a significant proportion were severe or life threatening. Quantification of complication risk may improve the informed consent process, perioperative planning, and donor care.",
author = "Ghobrial, {Rafik M.} and Freise, {Chris E.} and Trotter, {James F.} and Lan Tong and Ojo, {Akinlolu O.} and Jeffrey Fair and Fisher, {Robert A.} and Emond, {Jean C.} and Koffron, {Alan J.} and Pruett, {Timothy L.} and Olthoff, {Kim M.}",
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T1 - Donor Morbidity After Living Donation for Liver Transplantation

AU - Ghobrial, Rafik M.

AU - Freise, Chris E.

AU - Trotter, James F.

AU - Tong, Lan

AU - Ojo, Akinlolu O.

AU - Fair, Jeffrey

AU - Fisher, Robert A.

AU - Emond, Jean C.

AU - Koffron, Alan J.

AU - Pruett, Timothy L.

AU - Olthoff, Kim M.

PY - 2008/8

Y1 - 2008/8

N2 - Background & Aims: Reports of complications among adult right hepatic lobe donors have been limited to single centers. The rate and severity of complications in living donors were investigated in the 9-center Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL). Methods: A retrospective observational study design was used. Participants included all potential living donors evaluated between 1998 and 2003. Complication severity was graded using the Clavien scoring system. Results: Of 405 donors accepted for donation, 393 underwent donation, and 12 procedures were aborted. There were 245 donors (62%) who did not experience complications; 82 (21%) had 1 complication, and 66 (17%) had 2 or more. Complications were scored as grade 1 (minor; n = 106, 27%), grade 2 (potentially life threatening; n = 103, 26%), grade 3 (life threatening; n = 8, 2%), and grade 4 (leading to death; n = 3, 0.8%). Common complications included biliary leaks beyond postoperative day 7 (n = 36, 9%), bacterial infections (n = 49, 12%), incisional hernia (n = 22, 6%), pleural effusion requiring intervention (n = 21, 5%), neuropraxia (n = 16, 4%), reexploration (n = 12, 3%), wound infections (n = 12, 3%), and intraabdominal abscess (n = 9, 2%). Two donors developed portal vein thrombosis, and 1 had inferior vena caval thrombosis. Fifty-one (13%) donors required hospital readmission, and 14 (4%) required 2 to 5 readmissions. Conclusions: Adult living liver donation was associated with significant donor complications. Although most complications were of low-grade severity, a significant proportion were severe or life threatening. Quantification of complication risk may improve the informed consent process, perioperative planning, and donor care.

AB - Background & Aims: Reports of complications among adult right hepatic lobe donors have been limited to single centers. The rate and severity of complications in living donors were investigated in the 9-center Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL). Methods: A retrospective observational study design was used. Participants included all potential living donors evaluated between 1998 and 2003. Complication severity was graded using the Clavien scoring system. Results: Of 405 donors accepted for donation, 393 underwent donation, and 12 procedures were aborted. There were 245 donors (62%) who did not experience complications; 82 (21%) had 1 complication, and 66 (17%) had 2 or more. Complications were scored as grade 1 (minor; n = 106, 27%), grade 2 (potentially life threatening; n = 103, 26%), grade 3 (life threatening; n = 8, 2%), and grade 4 (leading to death; n = 3, 0.8%). Common complications included biliary leaks beyond postoperative day 7 (n = 36, 9%), bacterial infections (n = 49, 12%), incisional hernia (n = 22, 6%), pleural effusion requiring intervention (n = 21, 5%), neuropraxia (n = 16, 4%), reexploration (n = 12, 3%), wound infections (n = 12, 3%), and intraabdominal abscess (n = 9, 2%). Two donors developed portal vein thrombosis, and 1 had inferior vena caval thrombosis. Fifty-one (13%) donors required hospital readmission, and 14 (4%) required 2 to 5 readmissions. Conclusions: Adult living liver donation was associated with significant donor complications. Although most complications were of low-grade severity, a significant proportion were severe or life threatening. Quantification of complication risk may improve the informed consent process, perioperative planning, and donor care.

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