Donor Complications of Adult Living Liver Transplantation

Abstract

The liver is the largest of the abdominal viscera, occupying a substantial portion of the upper abdominal cavity. It performs a wide range of metabolic activities necessary for homeostasis, nutrition and immune defence. There has been a significant increase in the number of patients listed for liver transplantation in the past 10 years. The increase in organ demand has exceeded the supply, resulting in longer waiting periods and higher rates of death while on waiting lists. Approximately 10% of patients on transplant lists will die each year without receiving an organ. In adult LDLT, donor safety is of paramount importance, and ideally, there should not be any donor deaths. However, it is unrealistic to expect zero mortality with major hepatic resections, even in the healthiest subjects. All donors must fulfill the general selection criteria and passed successfully through the various phases of donor preparation. Biliary and Vascular complications are the major complications that occur in the donor after LDLT, although wound infection, pneumonia, and other typical postoperative complications can occur. Biliary complications after liver transplantation remain a major source of morbidity and mortality. Although, the incidence has generally decreased due to the evolution of surgical techniques, complications still include biliary strictures, bile leaks, biloma, biliary stones or debris, and sphincter of Oddi dysfunction. Ischemia, reperfusion injury, hepatic artery thrombosis, cytomegalovirus infection, and primary sclerosing cholangitis are some of the risk factors that have been implicated in biliary complications. ERCP has diagnostic and therapeutic value in management of biliary complications. ERCP has proven to be safe and effective in the management of strictures, stones, sludge, biliary leakage and SOD resulting in lower utilization of surgical revision and PTC management . If dis¬tal obstruction exists, endoscopic sphincterotomy, with or without percutaneous transhepatic or endoscopic trans-sphincteric stent will allow decompression while spontaneous closure proceeds if fistula or leak present. Vascular complications following liver transplantation occur with an incidence of 5 to 25% and may involve the hepatic artery, portal vein, hepatic vein or inferior vena cava, e.g: Hepatic artey thrombosis and portal venous thrombosis. Colour Doppler ultrasound (US) is used as the main screening technique, while angiography is reserved for confirming US findings or when US findings are equivocal. Excellent results have been reported using multislice computed tomography angiography (CTA) in detecting vascular complications after liver transplantation. Contrast magnetic resonance angiography (MRA) is another alternative non-invasive technique for this purpose Morbidity rates associated with donation are directly related to the extent of resection. Most complications, including wound infections, pleural effusions, alopecia areata, and transient hyperbilirubinemia, are minor. More serious complications requiring reoperation have been reported: bile leaks, bile duct strictures, and bleeding. Bleeding and bile leaks most often present in the immediate-postoperative period. Most bile leaks occur from the cut surface of the liver and are easily managed conservatively with drainage. Most biliary strictures are identified late and often require endoscopic and/or surgical interventions. Also reported have been all of the usual culprits that can complicate any major abdominal procedure done with general anesthesia: deep venous thrombosis, pulmonary embolism, urinary tract infection, and pneumonia. Although the potential for psychological complications is important to consider, a number of quality-of-life studies among live liver donors have documented good psychological outcomes in these individuals. An expanding LDLT program should definitely shorten waiting time to transplantation for end stage liver disease patients and patients with early stage hepatocellular carcinoma or acute liver failure. This should decrease the number of patients dying while waiting for a liver. Understanding donor outcomes is important as it enables the transplant team to fully inform the potential donor. In addition, this information will help the transplant team improve their post operative management and plan for long-term follow-up after liver donation.