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Adverse Occurrence type:
A total of 36 life-threatening or nearly life-threatening complications developed in 34 of 1140 (2,98%) healthy individuals.
Time to detection:
Five complications during operative procedure, 26 early after surgery, 5 after 1 month.
Alerting signals, symptoms, evidence of occurrence:
Intra-operative complications considered portal vein injury (2 donors); vena cava inferior injury (2 donors); right posterior bile duct injury (1 donor); Six donors suffered from postoperative haemorrhage from the drain, requiring surgery to stop the bleeding. Seven donors suffered from bile leakage, requiring drainage (2 donors), subsequent surgery (3 donors) or suture repair (2 donors) A respiratory arrest within 1 hour post operatively occurred in four donors, requiring re-intubation and respiratory support, extubated soon thereafter without further complication. One donor suffered progressive respiratory difficulty, was re-intubated and diagnosed with a pulmonary thromboembolism Infected biloma requiring drainage with laparotomy was seen in three donors. One donor suffered from liver abscess/necrosis requiring a segment resection with drainage. Late (> 1 months post op) severe complications requiring surgery were seen five donors. Hepatic failure was seen in four donors, leading to liver transplantation in one donor.
Demonstration of imputability or root cause:
Intra-operative/post-operative complications are direct result of the intervention.
Suggest new keywords:
LDLT, LDH, living donor hepatectomy
Life-threatening or nearly life-threatening complications in living liver donors. Clin Transplant. 2018 Jun;32(6):e13262.
Expert comments for publication:
It is unclear how often serious complications occur in Living Donor Hepatectomy (LDH), figures range from less than 0,55 to 29%. The incidence of complications is probably related to experience. More experience leads to less serious complications. Information about the incidence of complications is limited since it is often related to the manageability: as long as complications are manageable, they are not reported. As a result, it is hardly possible to give a prospective donor the correct information about the risk of complications. Lack of information prior to the donor's decision making can lead to a negative donation experience.