Evaluation outcomes of donors in living donor liver transplantation：a single-center analysis of 132 donors

摘要

BACKGROUND: Donor safety has always been a major concern, and  potential  risk  to  the  donor  must  be  balanced  against recipient benefit. However, lack of a standardized and uniform evaluation of perioperative complications is a serious limitation of the evaluation of donor morbidity. This study was designed to evaluate the outcomes of donors in adult living donor liver transplantation (LDLT) using the newer Clavien classification system in a single center in China. METHODS: We  prospectively  analyzed  the  outcomes  of  132 consecutive living liver donors from 2005 to 2008 using the newer Clavien  classification  system.  The  preoperative,  intraoperative and postoperative data of the donors were collected and analyzed. Ordinal  regression  was  used  to  analyze  the  ordered  grades  of complications. RESULTS: Ninety-four  (71.2%)  of  the  donors  developed postoperative  complications  of  grade  I  (n=45,  34.1%),  grade II  (n=39,  29.5%)  and  grade  III  (n=10,  7.6%).  There  was  no death or grade IV morbidity. Hepatic functional impairment and  pleural  effusion  were  the  most  frequent  morbidities  for living  donors.  Fifty-three  donors  (40.1%)  developed  hepatic functional  impairment  of  grade  I  (n=40,  31.1%)  and  grade II  (n=13,  10.0%).  The  ICU  stay  (7.8±1.8  days)  and  length  of hospital stay (17.7±4.6 days) were significantly longer in donors with  grade  III  than  others.  Furthermore,  ordinal  logistic regression revealed that donor's older age (>40 years) and right hepatectomy were associated with morbidity. In addition, only preoperative  total  bilirubin  (within  the  normal  range)  and postoperative  nadir  serum  phosphorus  were  independently associated  with  hepatic  functional  impairment.  The  receiver operator  characteristic  curve  revealed  that  preoperative  total bilirubin  >18.0  μmol/L  and  postoperative  nadir  of  serum phosphorus  <1  mg/dL  may  lead  to  more  severe  hepatic functional impairment. CONCLUSIONS: Despite the fact that donors are relatively safe to  undergo  hepatectomy,  many  living  donors  still  experience postoperative morbidity. Meticulous technical and preoperative donor evaluation and treatment are sure to reduce the incidence of complications.