Incidence and Risk Factors of Intraoperative Adverse Events During Donor Lobectomy for Living-Donor Liver Transplantation: A Retrospective Analysis

Abstract

Objective: To evaluate the frequency, type, and predictors of intraoperative adverse events during donor hepatectomy for Living-Donor Liver Transplantation (LDLT). Material and methods: Retrospective analysis of 182 consecutive LDLT donors' data between May 2002 and September 2008. Results: Ninety one patients (50%) had at least 1 intraoperative adverse event including hypothermia (39%), hypotension (26%), need for transfusions (17%), and hypertension (7%). Patients who had an adverse event were older (p=0.001), had a larger graft weight (p=0.023), more frequently underwent right hepatectomy (p=0.019), and more-frequently were classified as American Society of Anesthesiologists physical status class II (p=0.027) than those who did not have these adverse events. Logistic regression analysis revealed that only age (95% confidence interval 1.018-1.099, p=0.001) was a risk factor for intraoperative adverse events. Patients with these adverse events more frequently required intensive care unit admission and were hospitalized longer postoperatively. A before-after analysis showed that after introduction of in-line fluid warmers and more frequent use of acute normovolemic hemodilution the frequency of intraoperative adverse events were significantly lower (80% vs 29%, p< 0.001). Conclusions: Intraoperative adverse events such as hypothermia and hypotension were common in LDLT donors, and older age was associated with an increased risk of these adverse events. However, the impact of these adverse events on postoperative recovery is not clear. (Approval from the Institutional Review Board and Ethics Committee of Baskent University)