Categories
Liver Donor Living Donor Research Psychosocial Risks

Psychiatric Complications in Living Liver Donors

The authors studied 142 donors who underwent live-donor liver transplantation at Nagoya University Hospital between April 2004 and July 2014. None of the living donors had pre-existing psychological complaints prior to donation.

 

4.2% developed psychiatric complaints after donation, including major depressive disorder, panic disorder, conversion disorder, and substance use disorder.

(my emphasis)

“all donors received anti-anxiety drugs, half took anti-depressants, and supportive psychiatric therapy was concomitantly provided to all subjects. The average treatment period was 53.3 months. Regarding subject outcomes, 50% donors achieved remission, and the other half continued treatment.”

 

The average treatment period was 4.5 years. Think of that whenever someone says that liver donation has no long-term consequences.

 
Kimura, H., Onishi, Y., Sunada, S., Kishi, S., Suzuki, N., Tsuboi, C., Yamaguchi, N., Imai, H., Kamei, H., Fujisiro, H., Okada, T., Ishigami, M., Ogura, Y., Kiuchi, T., & Ozaki, N. (2015). Postoperative Psychiatric Complications in Living Liver Donors Transplantation Proceedings, 47 (6), 1860-1865 DOI: 10.1016/j.transproceed.2015.06.021

Categories
Liver Donor Living Donor Research Living Donor Risks

Liver Regeneration in Living Donors

The authors examined the liver function and liver volume of 91 right liver lobe donors.

Within a year of donating, 96% had regained full liver function but only 85% had full pre-donation liver volume.

 

Unfortunately, these results say nothing about the long term risk of scarring (cirrhosis) or otherwise.

 
Duclos J, Bhangui P, Salloum C, Andreani P, Saliba F, Ichai P, Elmaleh A, Castaing D, & Azoulay D (2016). Ad Integrum Functional and Volumetric Recovery in Right Lobe Living Donors: Is It Really Complete 1 Year After Donor Hepatectomy? American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 16 (1), 143-56 PMID: 26280997

Categories
Follow-Up Liver Donor Living Donor Protections Living Donor Research Living Kidney Donor Psychosocial Risks

Living Donor Psychosocial Evaluations Are Inadequate

Seven European researchers, on behalf of the ELPAT Paychological Care for Living Donors and Recipients Working Group “performed a systematic literature review of guidelines, consensus statements, and protocols on the content and process of psychosocial screening of living kidney and liver donor candidatesThirty-four publications were identified, including seven guidelines, six consensus statements, and 21 protocols or programs.”

“Across 34 publications, 197 different psychosocial factors were identified that can be clustered into 42 psychosocial domains”. According to the researchers, this “broad spectrum” suggests that the transplant industry has no clear definition of what factors need to be identified and/or addressed.There was also a lot of discrepancy in terminology (e.g., psychological well-being, psychosocial stability, psychopathology) “and in the level of detail provided in defining each criterion: some authors only addressed broad “umbrella” terms, like psychiatric disorders, whereas others specified these (e.g., mood disorders (depression, anxiety), personality disorder (schizophrenia, borderline)). Moreover, some authors just listed factors without any clarification, whereas others provided detailed descriptions, together with examples from clinical practice. For example, Leo et al. explained why employment status is important, as employers are a principal source of economic support by providing sick leave or vacation time during postsurgical recovery.”

Here are some of the factors covered, from most common to least (From Table 4 in the paper):

  • Motivation-related factors: 73.5%
  • Coercion or Pressure to donate: 67.6%
  • Support before and after donation; 64.7%
  • Donor-recipient relationship: 58.8%
  • Current of Past psychiatric disorders: 50%
  • Competence: 47.1%
  • Financial Issues: 47.1%
  • Coping-related issues: 44.1%
  • Employment-related issues: 44.1%
  • Family-related issues: 41.2%
  • Ambivalence: 38.2%
  • Unrealistic Expectations: 32.4%
  • Cognitive Status: 29.4%
  • Health Behavior (eg. obesity, smoking, exercise): 23.5%
  • Potential Medical Risks and urgency of donation:: 8.8%
  • Health concerns during and after donation: 5.9%

“Most factors were not supported by evidence or were at least not referenced, making it unclear if they indeed predict poor outcomes in donor candidates.”

In layperson’s terms, this means no proof exists that any of the factors the evaluation examines (eg. drug abuse, history of depression] is linked to poor living donor outcomes. What this really means is that the transplant industry hasn’t taken the time to study living donors and quantify exactly how they fare post-donation and which attributes contribute to their well-being.

“Contraindications for donation [aka red flags, or reasons folks shouldn’t donate] were specifically stipulated in 18 papers (52.9%),of which only three indicated whether these were absolute or relative contraindications [‘relative’ meaning: well, maybe they shouldn’t donate, whereas ‘absolute’ means: no, absolutely not], and only one paper indicated that these were evidence-based”

 

Their final conclusion:

“At present, there is no consensus, nor strong evidence or concrete guidance on what to screen for, how to handle identified psychosocial problems, and how to perform the screening, leading to huge variability in screening practices,the risk that important psychosocial factors might be overlooked or that unnecessarily time-consuming and costly procedures are being undertaken.”

Read the whole thing at the link

 

Duerinckx, N., Timmerman, L., Van Gogh, J., van Busschbach, J., Ismail, S., Massey, E., Dobbels, F., & , . (2014). Predonation psychosocial evaluation of living kidney and liver donor candidates: a systematic literature review Transplant International, 27 (1), 2-18 DOI: 10.1111/tri.12154

Categories
Ethical Considerations Informed Consent Liver Donor Living Donor Research Living Donor Risks

Extended Criteria Liver Donors At Higher Risk For Complications

As the authors say: “Donor selection criteria are being continuously modified to expand the potential donor pool in living donor liver transplantation”

 

“Donors who were older than 55 years, and/or with BMI >30, and/or with a remnant liver volume of <30% were defined as extended criteria donors.”

(Think about that for a second; medical personnel who swear to “do no harm” are leaving someone with less than 30% of their liver. Ugh)

 

“Postoperative complications were observed in 17 (28%) of 61 extended criteria donors, and 53 (19%) of 281 non-extended donors”

“Complications developed in 3 of 7 donors aged >55 years and with BMI >30.”

“Grade IIIb complications were statistically significantly higher in the extended group. Having more than 1 extended criteria may increase the donor’s postoperative complications in LDLT. Thus, the elimination of the donors should be considered in the presence of more than 1 extended criteria.”

 

I have no idea how they can “eliminate” a donor with a 30% liver remnant considering they’re the ones removing the liver, but all right…

Bottom line: if you’re over 55 and/or have a BMI greater than 30, you probably shouldn’t be a live liver donor.

 
Dirican A, Ozsoy M, Ates M, Ersan V, Gonultas F, Isik B, & Yilmaz S (2015). Consequences of the use of extended criteria donors in living donor liver transplantation. Annals of transplantation : quarterly of the Polish Transplantation Society, 20, 211-7 PMID: 25877045

Categories
Follow-Up Liver Donor Living Donor Research Living Donor Risks Living Kidney Donor

American Society of Transplant Surgeons Winter Symposium 2015 Abstracts

Read ’em all here folks: http://onlinelibrary.wiley.com/doi/10.1111/ajt.13164/pdf

 

Long-Term Living Donor Outcomes: When To Say No Dorry Segev (Pg. 43).

“The risks of donation are real. And serious. And attributable to donating. In other words, there are things that might happen to an individual if he donates that would not happen to that individual had he not donated”

And

“And of course it will only get worse. No doubt as we follow the new cohort of donors with more medical issues (higher BMI, higher blood pressure, etc.) for much longer periods of time (current follow-up in large studies is relatively still “short-term” or “medium-term”), we will discover much more risk that donors take.”

 

Note: We/They aren’t following anyone. There is no living donor registry; we don’t even have one-year of comprehensive living donor data.

***

Non-Academic Transplant Business Intelligence – A Surgeon’s Perspective Robert Osorio (pg 47).

” transplant professional societies now host career development seminars to improve business intelligence among their membership. The paucity of literature is also improving, and reviews are now available regarding the finances of transplantation”

and

“In 2008, ASTS launched the first comprehensive compensation study for transplant surgeons practicing within the United States4 . These results have provided a better understanding of total compensation, including salary and benefits, of academic staff surgeons, program directors, and academic transplant surgeons in leadership positions. This type of study is readily used in compensation agreements requiring fair market value (FMV) estimates of salary for non-academic transplant surgeons who are in an employed model”

***

Eliminating the Significant Regional Variation in Donor Conversion Rates Provides the Most Significant Reduction To Waitlist Mortality. (pg 49)

” Redistricting might reduce waitlist mortality and potentially saves 563 lives over 5 years. Here we examine national donor conversion rates and waitlist opportunities.”

***

Hypertension and Diabetes in Live Kidney Donors and Matched Nondonors (pg 55).

“Living donors had lower diabetes than matched controls immediately after donation, but higher incidence past 10 years. Living donors had substantially higher long-term risk of diabetes. Risk of hypertension increased more quickly over time for black donors than nonblack donors. Hypertension incidence did not differ between donors and controls.”

***

Patterns of Physician Visits Before and After Living Kidney Donation (pg 66)

“Smokers, donors with less than college education, and male donors (particularly single men) are less likely to visit a PCP annually after-donation, and may benefit from targeted efforts to improve PCP followup.”

***

Predonation Characteristics Associated With Risk of End-Stage Renal Disease in Live Kidney Donors (pg 70)

“Obese donors and those with a high blood pressure have signifi – cantly higher 15-year risk of ESRD compared with other donors.”

**

Outcomes After Right Kidney Living Donor Transplant Are Associated With Center Volume (pg 76)

“RKLDT [Right Kidney Living Donor Transplant] is associated with a higher rate of GF [Graft Failure} among centers performing <12 RKLDT annually, whereas there is a 2-fold reduction in the RR of GF among experienced centers ( >12 RKLDT /year).”

**

Analytic Morphomics Do Not Predict Long-Term Outcomes in Living Kidney Donors (pg 83)

“Survey results were obtained from 598 living kidney donors (response rate 57.6%). The mean follow-up time from donation was 9.1 years. “

And

” however, 17.0% of patients reported new diagnosis of at least one significant cardiovascular risk factor including: diabetes(2.5%), hypertension(14.0%), kidney disease(1.0%), heart attack(0.3%), and stroke(1.3%).”