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 19 February 2018

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News

Living donor complications avoidable through strict selection

Most living donor complications are avoidable through strict selection of living donor and graft type, postoperative surveillance, and timely feedback of surgical techniques, find doctors in June's issue of Liver Transplantation.

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Serious complications have occurred in a considerable proportion of living donors of liver transplants.

Data from a single high-volume center has rarely been available.

Dr Sung-Gyu Lee and colleagues from Korea analyzed the medical records of donors and recipients.

The doctors assessed the first 1000 living donor liver transplants performed at Asan Medical Center from 1994 to 2005, with a focus on donor safety.

The team assessed 107 pediatric and 893 adult transplants.

The most common diagnoses were biliary atresia in pediatric recipients, found in 63% of patients.

The team also diagnosed Hepatitis B-associated liver cirrhosis in 80% of adult recipients.

5-year survival rates were 83% in adult recipients
Liver Transplantation

Right lobe donors were strictly selected based on liver resection rate and steatosis.

The doctors evaluated 1162 living donors.

In total, 588 right lobes, 6 extended right lobes, 7 right posterior segments, 464 left lobes, and 107 left lateral segments were obtained.

Of these, 837 grafts were implanted singly, whereas 325, along with 1 cadaveric split graft, were implanted as dual grafts into 163 recipients.

The team found that the 5-year survival rates were 85% in pediatric recipients, and 83% in adult recipients.

There was no donor mortality, but 3% of donors experienced major complications.

Until the end of 2001, the team noted that the major donor complication rate was 7 %, with most occurring in right liver donors.

Since 2002, liver resections exceeding 65% of whole liver volume were avoided.

The doctors noted that there was an exception for young donors with no hepatic steatosis.

The donor complication rate has subsequently been reduced to 1%.

Dr Lee's team commented, “A majority of major living donor complications appear to be avoidable through the strict selection of living donor and graft type, intensive postoperative surveillance, and timely feedback of surgical techniques.”

“Selection of right lobe graft should be very prudently considered if the donor right liver appears to be larger than 65% of the whole liver volume.”

Liver Transplant 2006: 12(6): 920-7
26 May 2006

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