Ascertaining the exact nature and frequency of complications for living donors is nearly impossible for multiple reasons. Some transplant centers or studies only consider those issues that result in rehospitalization or occur within a certain time period. Some living donors seek care at a facility other than the transplant center so they go unreported. Some transplant centers are lax in reporting data to OPTN, even though it is a federal mandate**.
A 2004 World Transplant Consortium admitted that some physicians will not report a medical issue as a consequence of living donorship out of fear of retribution for the donor from their insurance company.
Complications that donors report during the first year post-donation are higher than previous reports. Rates reported by the transplant programs may greatly underestimate the actual complication rates. Retrospective surveys rely on the responder's memory of complications and their desire to be forthright. Additionally, many donors come from outside of the state to donate, therefore the transplant program may not be aware of the donor complications.
According to data from UNOS and SRTR, 267 living donors sought hospital readmission in the first year post-surgery from January 2008-March, 2009.
.6% within six weeks; 2.3% between six-weeks and six-months; 1.5% between six-months and one-year.
**3060 of 7481 living donors were 'lost to follow-up' by 12 months, so OPTN is missing chunks of data**
LODN, the living donor insurance program, shows a “serious complication” rate of 3.3% (those requiring overnight hospitalization or an operation), and “complications other than serious” at 17%. (136)
Perioperative risks include, but are not limited to, the following (28, 46,47, 49, 50, 111):
- pneumothorax: abnormal air presence in the chest cavity which can result in lung collapse.
- small peritoneal damage: peritoneal refers to the
membrane surrounding the abdomen and its inclusive organs.
- superficial wound
- deep wound infection
- urinary tract infection
- renovascular injury: damage to the blood vessels associated with the kidneys.
- bowel injury and/or obstruction (ilieus)
- Epigastric artery injury: arteries in the upper center region of the stomach.
- hematoma: otherwise known as a bruise, can be caused by internal bleeding.
- pulmonary embolism: blockage of the a main lung related artery; cessation of blood to the lungs.
- orchalgia: chronic pain of the testicles.
- epididymitis: inflammation of the small tube that rests on top of the testicle, part of the system that carries sperm from the testicle to the penis.
- transient neuromuscular injury
- nerve entrapment
- lap neuroma: growth or tumor of nerve tissue.
- bleeding ulcer
- spleen injury, sometimes requiring conversion to open surgical procedure.
- liver bleeding
- acute renal/kidney failure
- bradycardia: abnormally slow heart rate.
- hemorrhage: bleeding, sometimes requiring conversion to open surgical procedure.
- anemia: low blood iron.
- anaphylactic reaction: allergic reaction.
- urinary retention and/or infection
- dyspnea: shortness of breath, difficulty breathing.
Early postoperative complications reached a mean of 9%. Conversion rates from 0-13% due to bleeding or vessel injury, inadequate exposure and obesity, stapler malfunction and loss of pneumoperitoneum. (50)
Post-op complications observed in 19%. No deaths.
The complication rate was
14%, the rate of open conversion was 2%, and 3% of the patients
required transfusions. Complication rates of laparoscopic and open
Study of 86 living kidney donors revealed a total complication rate of 54.6%. (91) Serious complications occurred in five cases (5.8%). (91)
Perioperative complications and wound healing issues were reported by 23.07% of the donors.
Serious complications were reported by 7.7% of the donors in this registry. There was no difference between the type of donation procedure (open vs. laparscopic) and the complications reported.
7.7% reported they were treated for genitourinary problems.
(This only ONE YEAR post-donation!)(28)
5% reported that surgery was complicated by a problem that increased hospital stay or time away from normal life beyond their expectations.(4)
Complications not requiring re-operation were reported for 19 (0.3%) open, 22 (1.0%) hand-assisted LN, and 24 (0.8%) non-hand-assisted LN cases (P .02). Readmission rate was higher for LN (1.6%) versus open (0.6%) donors (29)
Conversion rates 6-13%.
The most important reason for conversion is bleeding. Reoperation is
1-5% for hemorrhage, small bowel obstruction, internal hernia,
splenic injury, retrieval of foreign body and wound neuroma.
Perioperative morbidity in lap was 14%, wound complications 6.8% (51)
Donor complications following lap-total complication rate was 16.5%. (52)
The overall rate of intraoperative complications was 2.8%. The overall rate of postoperative complications was 3.4% and included urinary retention, wound infection, temporary lateral thigh numbness, chylous ascites, and nerve entrapment. Thirty of 500 patients in our LDN series experienced an intraoperative or procedure-related complication (6.0%). (53)
Major intraoperative complications was 6.8% and major postoperative complications in 17.1%. Major complications presented a significant risk to the donor. Included vascular injuries (renal artery, renal vein, aorta, common iliac artery, vena cava and mesenteric veins) and bowel injuries. Minor complications redressed laparoscopically and were not thought to present a significant risk—included splenic laceration, liver laceration, pneumothorax, diaphragm injury, stapler misfiring, controlled injury to vein or arteries, cardiac arrhythmias, and urethral strictures. Major postoperative complications included atrial fibrillation, small bowel obstruction requiring return to the OR, sepsis, respiratory distress, pneumonia, retroperitoneal hematomas, and a splenic laceration requiring reoperation. The major complication is bowel function. May take 7-10 days to return to normal. A major complication is internal hernia. (54)
Complications can include a wide range of medical problems, from infections and bile leaks to pulmonary embolism and deep vein thrombosis. (55)
A conference of more than 90 experts who met in Vancouver in May 2007 and reviewed data from around the world found that 35% of liver donors are likely to have complications, including pneumonia, renal failure and repeat surgery. The time frames for follow-up varied among the research examined, but most complications arise shortly after surgery. Data from a national study that reviewed a sample of liver donors from 1998 to 2003 found a similar complication rate of 38%, with a median follow-up time of six months. (55)
Out of 65 living related kidney donors in Germany, 28% experienced medical complications.
Last updated: 11-11-2010
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