A clinical study conducted at multiple sites across the United States has extensively described donor risk of long-term complications from living donor liver transplantation. Liver transplantation is the only option for those with end-stage liver disease, but the supply of organs available from deceased donors is severely limited relative to demand. Living donor liver transplantation can alleviate this problem, but potential risks to the donor must be investigated thoroughly prior to widespread use. For this purpose, the NIDDK’s Adult-to-Adult Living Donor Liver Transplantation cohort study undertook an assessment of the incidence, severity, and natural history of donor complications from living liver donation. At 9 transplant centers throughout the United States, the investigators studied over 700 living liver donors over a 12-year period, the longest ever for a study of complications in these donors. They found similar rates of complications to previous, shorter-term studies, with 40 percent of donors having one or more complications and 19 percent experiencing multiple complications. The donors’ estimated chances of disability, liver failure, or death after the procedure were 1 percent. Within the first few weeks after the transplant procedure, the most common complications were infections, excess fluid around the lungs, bile leaks, nerve damage, and bowel obstruction. Most of these complications resolved within 3 months after the procedure and, overall, 95 percent of complications were resolved within 1 year. Longer-term complications in the following months or even 5 to 6 years later included hernia, bowel obstruction, and psychological complications. Factors predicting a greater chance of complications included the donor’s need for blood transfusion and low blood pressure during the procedure, features that are characteristic of more prolonged and complicated surgery. Other factors that predicted specific serious complications included higher body weight, older age, and male gender. Surprisingly, among the nine transplant centers participating in the study, all of which had past experience in performing liver transplants, the extent of the center’s experience in performing the procedure did not significantly predict donor complications. Further research will be needed to assess the long-term risk to donors of living donor liver transplantation as this procedure continues to evolve. These findings can be used to focus efforts on reducing the rate of complications and are invaluable in aiding the decision-making process of individuals who are considering becoming living liver donors and their loved ones.
Abecassis MM, Fisher RA, Olthoff KM, et al. Complications of living donor hepatic lobectomy—a comprehensive report. Am J Transplant 12: 1208-1217, 2012.