78 percent of living right liver donors experienced post-operative complications

More than 78 percent of living right liver donors experienced post-operative complications, according to a new study that uses a replicable complication classification system. Most of the complications were minor, though some were more serious.

The full findings are published in Liver Transplantation, a journal by John Wiley & Sons. The article is also available online via Wiley Interscience.

The demand for donor livers far outstrips the supply from deceased donors, so living donor liver transplantation has become increasingly common ever since it was first reported successful in 1989. While a donor left hepatectomy is associated with fewer complications than a right hepatectomy, often the right liver is needed to meet the metabolic demands of large recipients. Complication rates from right hepatectomy have been reported to range between 0 percent and 67 percent, depending on the definition of morbidity.

In an effort to pinpoint the true complication rate for living right liver donors, researchers led by Kyung-Suk Suh of Seoul National University College of Medicine, prospectively analyzed the outcomes of 83 consecutive living donor right hepatectomies using a standardized classification of the severity of complications. They used a modified Clavien system: Grade I=minor complications; Grade II=potentially life-threatening complications requiring pharmacologic treatment; Grade III=complications requiring invasive treatment; Grade IV=complications causing organ dysfunction requiring ICU management; Grade V=complications resulting in death. (Please note that the original classification of postoperative complication was suggested by Clavien et al and Broering et al.)

The study took place between January 2002 and July 2004 at the Seoul National University Hospital and the donors, usually offspring of the recipients, underwent either right hepatectomy or a modified extended right hepatectomy. The researchers monitored them for complications for 12-months after their surgery.

There were no significant differences in the types and incidences of complications between the donors who underwent right hepatectomy and those who underwent modified extended right hepatectomy Overall, 65 of the 83 donors (78.3 percent) experienced complications. "Most were minor and self-limited or were silent in that they were only noted in laboratory and protocol imaging studies," the authors report. "However, several patients experienced potentially life-threatening complications requiring additional treatment."

Sixty-four patients (77.1 percent) had Grade 1 complications, most commonly hyperbilirubinemia and pleural effusion. Eleven donors had Grade II complications, mostly bile leakage. One donor had a Grade III complication. And no donors had Grade IV or IV complications. At the one-year follow-up, 93 percent of donors had normal bilirubin and ALT levels.

"In conclusion, although most of these adverse events were minor and self-limited, 78 percent of right liver donors still experienced morbidity," the authors report. "Therefore, continuous standardized reporting of the donor morbidity as well as meticulous surgery and intensive care is essential for the success of donor right hepatectomy implementation."

An accompanying editorial by Yasuhiko Sugawara et al. of the University of Tokyo praised the effort to introduce a standardized assessment system to evaluate the rate of complications for living liver donors. "The modified Clavien's classification system introduced in 2004 is simple and informative. We believe its use will greatly enhance the comparison of living donor liver transplantation outcomes," the authors write. "From now on, the modified Clavien's classification system should be used whenever surgical complications of live liver donors are discussed."