Donor Morbidity Including Biliary Complications in Living-Donor Liver Transplantation

Abstract

We read the article titled “Donor morbidity including biliary complications in living-donor liver transplantation: a single-center analysis of 827 cases” by Shin et al. (1), in the May 2012 issue of Transplantation with great interest. The overall complication rated was 10.0% including the biliary complications; the most common complications were the Wound complications (5.8%), and the grade I, grade II, grade IIIa, grade IIIb complications were experienced in 56 (67.5%), 2 (2.4%), 15 (18.1%), and 10 (12.0%) donors, respectively. Donor morbidity did not decrease below the attained level even after time had passed. We reviewed 283 consecutive living-donor liver transplantations (LDLTs) performed at our center between March 2002 and April 2012. Our volume of LDLT was the largest in mainland China and took almost a quarter of the total amount. There was no difference in the donor’s demographic characteristics and intraoperative data (see Table 1, SDC, https://links.lww.com/TP/A695); however, there was less blood loss in the post-2008 period with 567.68±578.4 mL than in the pre-2008 period with 693.28±556.6 mL (P<0.05). Meanwhile, operational time was also shorter with 6.03±1.30 hr in the second stage (7.41±1.54 hr in the first stage) (P<0.05); the hospital stay days in the first stage were 12.77±4.55 days but 8.89±3.43 days in the later stage (P<0.05). The reason for those improvements were more professional techniques in surgery and anesthesia after January 2008. Many new techniques and equipment might also contribute to those improvements. The overall complication rate was 24.7%, which was higher than the 10% reported by Shin et al. (1). Half of those complications (54.3%) were minor complications (grade 1). Fourteen patients experienced biliary complications: seven patients with grade 1, four patients with grade 2, and three patients with grade 3 (2 with grade IIIa and 1 with grade IIIb), thus they were the most common complications with a incidence of 4.9%. This was in accordance with the report of Shin et al. (1). Less severe complications (≥grade III) were observed in our report than theirs, and more complications were observed in the right lobe donors (66 cases) than the left lobe donors (4 cases, 8.2%) (see Table 2, SDC, https://links.lww.com/TP/A695), there was no complication in the left lateral hepatectomy. In the first stage, the complication rate was 31.8%, which was much higher than that of the second stage, which had a complication rate 18.8%. The each grade complication rate was much higher in the first stage than in the second stage (P<0.05). There was no grade 4 or 5 complication, no organ dysfunction or donor morbidity. Almost all complications occurred in the first year except for one donor, who experienced incomplete intestinal obstruction in the third year after operation. Decreased morbidity after January 2008 strongly correlated with our center’s improving experiences and new equipment and techniques. New technology such as laparoscopic-assisted and minimal-acces live-donor hepatectomy has been applied as an effective and safe way to living-donor liver resection in our liver transplantation center. Meanwhile, upper midline incision with or without laparoscopic assistance can be used for LDLT with less pain and without impairing safety, reproducibility, or effectivity. Closer cooperation between the surgeon, the anesthesiologist, and the nursing and supporting staff may have also contributed to the improvement. In summary, with the advancement in the graft resection and other new techniques and ideas, significant improvements were observed in the complication rate. Jianyong Lei Lunan Yan Liver Transplantation Center West China Hospital of Sichuan University Chengdu, China