Daniel M. Keller, PhD

April 13, 2011

April 13, 2011 (Berlin, Germany) — Living donor liver transplantation (LDLT) using partial hepatectomy can be done with a very low risk for mortality to the donor, but postoperative complications are common, affecting 24% of donors, Canadian researchers announced here at the European Association for the Study of the Liver (EASL) 46th Annual Meeting.

Comorbid conditions raise the risk for donors. Because donors are generally healthy people to begin with, concerns persist about the high morbidity and risk for mortality, said Kelly Burak, MD, MSc, associate professor of medicine in the liver unit of the Department of Medicine at the University of Calgary in Alberta, Canada.

Dr. Burak told Medscape Medical News that the impetus for the study was to see if complications of LDLT were being reported accurately. "Nobody likes to publicize their complication rates or the very high-profile donor deaths that have occurred with live donor liver transplant," he said.

Dr. Kelly Burak

Dr. Burak and colleagues searched the Nationwide Inpatient Sample Database, a 20% sample representing about 90% of hospitalizations in the United States, for LDLT and complications and identified 587 patients who had a resection of part of their livers for live donation. They captured about 84% of all cases reported by the United Network for Organ Sharing at that time, which correlated well with the 90% expected rate from the database.

The donors were 18 to 65 years of age (median age, 34 years) and 96% of the procedures were performed at urban teaching centers; the average annual number of resections for LDLT was 2 (range, 1 to 26). About half of the donors were women, about half were white, about half had private insurance, and 80% had no comorbid condition. The median length of hospital stay was 6.1 days.

No donors died, but 24% (n = 139) had complications, including 7% (n = 40) who required a secondary procedure. The most common complications were gastrointestinal (11.0%), pulmonary (5.3%), and infectious (3.4%). The most common secondary procedures were transfusion (4.0%) and biliary surgery (1.2%).

In a multivariate analysis adjusted for patient demographics, year, region, and hospital volume of liver transplants, the risk for complications increased with the presence of any comorbidity (odds ratio, 1.68; 95% confidence interval, 1.06 to 2.68).

Dr. Burak said that the surgery can be performed safely with a low mortality risk, although donor deaths have occurred. "Patients who are thinking about this have to understand that probably, realistically, 1 in 4 people will have some type of complication following the surgery," he warned. "Most donors, I think, are willing to accept those risks. This is just an important piece that adds to the informed-consent process for live liver donation."

In a news conference on liver transplantation, Daniele Prati, MD, director of the Department of Transfusion Medicine and Hematology at the Ospedale Alessandro Manzoni, in Lecco, Italy, and a member of the EASL Scientific Committee, noted that LDLT is different from kidney donation in terms of risk to the donor, raising some ethical issues. "There are some postsurgical morbidities . . . that make this approach not very, very convincing at the present. This is my opinion," he said. Dr. Prati was not involved in the Canadian study.

Patrizia Burra, MD, PhD, head of the multivisceral transplant unit and chief of the Cell Therapy Regional Centre for Metabolic Liver Diseases at Padua University Hospital in Italy, also not involved in the study, noted that a complication for the donor could result in a long hospitalization and loss of time from work.

"I think we have to consider not only the health but also all the situations — psychological, the quality of life, returning to employment," she said. In this regard, the selection of the donor is critical to minimize the possibility of postoperative complications "because the donor is a healthy person."

As hepatologists, "we have the great task of evaluating the donor, so we should really be absolutely sure that he has not any sort of risk factors for the regeneration [of the liver]." With the prevalence of metabolic syndrome reaching 25% of the population, steatosis, high blood glucose, and mild hypertension are all concerns, Dr. Burra said. If the donor has "unrecognized mild steatosis, maybe the regeneration of the liver will be not that perfect," she advised.

The study had no outside funding. Dr. Burak, Dr. Prati, and Dr. Burra have disclosed no relevant financial relationships.

European Association for the Study of the Liver (EASL) 46th Annual Meeting. Presented April 1, 2011.

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