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Morbidity in Live Liver Donors
Standards-Based Adverse Event Reporting Further Refined
Christopher R. Shackleton, MD;
John M. Vierling, MD;
Nicholas Nissen, MD;
Paul Martin, MD;
Fred Poordad, MD;
Tram Tran, MD;
Steven D. Colquhoun, MD
Arch Surg. 2005;140:888-895.
Hypothesis The true extent of morbidity among live liver donors remains poorly understood. In this unique and often high-profile area of surgery, the development of standards for defining and reporting complications would foster a better understanding of the incidence and magnitude of such adverse events (AEs).
Design Retrospective review of AEs among live liver donors.
Setting University-affiliated teaching hospital.
Patients and Methods Of 202 individuals undergoing evaluation for live liver donation, 42 (20.8%) proceeded to surgery. Thirty-four underwent a right lobectomy without the middle hepatic vein; 3, a left lateral segmentectomy. Any event causing a deviation from a patient’s ideal course was considered an AE and subsequently classified according to a derived framework. Morbidity was defined as 1 or more AEs.
Main Outcome Measures Incidence, timing, type, severity, and impact of AEs.
Results No deaths or significant hepatic dysfunction occurred. In 5 (12%) of the 42 donors, the hepatectomy was aborted for anatomic reasons before parenchymal transection. Eight (22%) of the remaining 37 experienced 11 AEs, of which 10 completely resolved, whereas 1 AE (3%) resulted in a permanent disability (brachial plexopathy). The overall incidence of AEs was 0.30 per case. Ten (91%) of the 11 AEs presented within the first postoperative month.
Conclusions Most live liver donations are uncomplicated or do not lead to permanent consequence. The adoption of a standards-based classification framework for AEs in live liver donors would allow for an inclusive, consistent, and universally applicable method to collect, analyze, and report donor morbidity.
Author Affiliations: Center for Liver Diseases and Transplantation, Cedars-Sinai Medical Center (Drs Shackleton, Vierling, Nissen, Martin, Poordad, Tran, and Colquhoun), and Departments of Surgery (Drs Shackleton, Nissen, and Colquhoun) and Medicine (Drs Vierling, Martin, Poordad, and Tran), The David Geffen School of Medicine at UCLA, Los Angeles, Calif.
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