Pregnancy and Delivery After Partial Liver Donation for Living-Donor Liver Transplantation

Abstract

In Japan, since the organ transplant law was enacted in 1997 (1), only 35 liver transplant operations using brain-dead donors have been performed as of December of 2006. In contrast, 3218 cases of living-donor liver transplantation (LDLT) have been performed with a dramatically increasing frequency since 1989. In Japan, the first donor death after LDLT was reported in 2004 (2). The Japanese Liver Transplantation Society has established a donor survey committee that has investigated all LDLT cases in Japan. In addition to operative morbidity such as biliary fistula, gastric stasis, and wound infection (3), difficulty in performing sexual intercourse or menstrual irregularity has also been reported in 1.7% and 2.7% of the cases, respectively (unpublished data). Anxiety about pregnancy or delivery among female donors has also been reported. At our institution, a 29-year-old woman donated her right liver lobe to her mother. Afterward, she was diagnosed to be pregnant within 6 months of organ donation, and her subsequent course and delivery was successful. Sixty-two LDLT cases have been performed at our institution from 1997 to December 2006, including 31 female live donors. Our female live donors consisted of eight individuals in their twenties, 10 in their thirties, 10 in their forties, and three in their fifties, respectively. The relationship between the donors and recipients were either daughter (n=9), mother (n=8), wife (n=7), sister (n=5), aunt (n=1), or niece (n=1). Since the Japanese national health insurance system began to cover adult-to-adult living-donor transplantation in January 2004, the fertility ratio of the donors have gradually increased in our institute. Currently, two of the aforementioned donors have become pregnant. Although pregnancy of liver transplantation recipients has been reported in detail (4), this is the first report about the pregnancy of a donor shortly after donation. The physiology after partial liver donation should be the same as is observed in patients after hepatectomy for other liver disease in fertile woman. However, there have been no case series on pregnancy in such cases. In addition, to elucidate the quality of life of living liver donors and to resolve their anxiety regarding pregnancy, we should therefore follow the reproduction history of donors and establish a follow-up program regarding such pregnancy cases with obstetric and gynecological departments. There was a recent report about the sexual health of a recipient after transplant (5); however, the sexual problems among donors after LDLT have not yet been thoroughly studied. In the present study, we herein report the feasibility of pregnancy even soon after donation of the liver for transplantation. Akihiko Soyama Susumu Eguchi Mitsuhisa Takatsuki Masaaki Hidaka Kosho Yamanouchi Yoshitsugu Tajima Takashi Kanematsu Department of Surgery Nagasaki University Graduate School of Biomedical Sciences Nagasaki, Japan