An analysis of the surgical and perioperative complications in right hepatectomies

Adult living related liver donors play an essential role in filling the gap of transplants needed due to a heavy shortage of cadaveric donations. Considering that living related donors are healthy individuals at baseline, it is imperative to ensure good outcomes and return to quality of life. A research article to be published on 28 May 2008, in the World Journal of Gastroenterology addresses this question. The research team led by Prof. Salvatore Gruttadauria from Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione designed an accurate, comprehensive step-by-step work-up protocol for donor evaluation to ensure donor safety and to confirm that the donor is capable of providing a suitable graft.

The strategy of careful evaluation of the living donor performed by an interdisciplinary team cannot be overemphasized. Their research has proven the necessity of evaluating the overall health of both the donor and recipient at many different levels from biopsy to body mass index. Their research has indicated liver biopsy in the exclusion of potential donors otherwise considered fit to donate. These biopsies assess the quality of the donation to ensure the likelihood of success of the transplant and the health of both the donor and the recipient.

Authors' experience shows that heavier donors, when subjected to an exercise and diet program, all return to previous activity. In fact, no life threatening complications, long term impairments, or deaths have occurred in these donors.

With all of this in mind, the study was designed to evaluate operative complications in a series of seventy five patients. In heir series, 30.6% of living donors developed a complication in the perioperative period. Complications related to biliary tree reconstruction (9.33%) were the most common, although no patients had to undergo repeated open surgery. None of the 75 live donors in the series, regardless of their post-operative course, manifested any regrets about live donation.

In conclusion, the study reports the largest Italian experience on right hepatic liver donation, focused on perioperative complications and on donor safety, which must be the first priority. The need to define, categorize and record complications when healthy individuals, such as living donors, undergo a major surgical procedure like a right hepatectomy reflects the need for prompt and detailed reports of complications arising in this particular category of patient.

Source: World Journal of Gastroenterology