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Liver Donor Living Donor Research Living Donor Risks

Overview of Living Liver Donation

The article is free and publicly available; I encourage everyone to read it in full.

 

 …any adverse event in an altruistic donor who did not otherwise require an operation is cause for concern. Significant donor morbidity, including death, has been observed, even among the most experienced centers.

 

… it is impossible to make the risk negligible for an operation of such magnitude. Counseling a potential donor with respect to the risks involved in donor hepatectomy is ethically mandated before proceeding with LDLT, but until recently there have been few registry data to allow an estimation of true risk, and the ability to provide truly informed consent continues to be a challenge and deserves further study.

 

Current available data suggest that overall donor mortality after liver donation in the United States and Europe is on the order of 0.2%

I want to note here that A. I’m not sure where they get this statistic (I’m assuming from OPTN data, which is very limited), and B. they are lumping together right and left lobe donors. The left lobe is smaller and used for children; the right is larger and transplanted into adults. The death and complication rate for adult-to-adult living liver donation is much higher than pediatrics (See here).

 

 In studies that have included donors of either the right or left hepatic lobe, the overall complication rate has been approximately 21%. However, in studies including only right hepatic lobe donors, complications rates are higher and have ranged between 38% and 47%

 

Of all donor complications reported by the A2ALL consortium, infections, pleural effusion, biliary leak, and incisional hernia were the most common

 

Most laboratory abnormalities that occur in donors after lobectomy resolve quickly, and 20% of donors have persistently lower platelet counts 2 to 3 years after donation, although the clinical significance of this finding is unknown.

 

Liver failure requiring rescue transplantation is extremely rare; only five cases have been reported in the literature, four of which involved right lobe donors.

“Reported in the literature” because again, the US has no national registry for living donors, and reporting to OPTN has been less than optimal.

 

Finally, the authors report no long-term information on living liver donors’ health and well-being because no one *has* long-term data.

 

 
Paige M. Porret, Kim M. Olthoff* (2013). Current state of living donor liver transplantation Clinical Liver Disease DOI: 10.1002/cld.231

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