BACKGROUND: After right lobe donation, biliary complication is the main cause of morbidity. Mortality after right lobe donation has been estimated to be less than 0.5%. PATIENTS AND METHODS: Between November 2001 and December 2008, 207 adult-to-adult living donor liver transplantations (ALDLT) were undertaken using right lobe grafts. Donors included 173 men and 34 women with a mean age of 28.4 +/- 5.2 years. RESULTS: Siblings comprised 144 (69.6%) cases whereas unrelated donors comprised 63 (30.4%) with a mean body mass index (BMI) of 25.2 +/- 2.4. Single and multiple right hepatic ducts (RHD) were present in 82 (39.6%) and 125 (60.3%) donors, respectively. Mean operative time was 360 +/- 50 min with an estimated blood loss of 950 +/- 450 ml and returned cell-saver amount of 450 +/- 334 ml. Mean donor remnant liver volume was 33.5 +/- 3.2%. Mean intensive care unit (ICU) stay was 3 +/- 0.7 days and mean hospital stay was 14 +/- 3.5 days. Modified Clavien classifications were used to stratify all donor biliary complications The overall biliary complications occurred in 27 cases (13.0%). After modified Clavien classification, biliary complications were graded as grade I (n= 10), grade II (n= 2), grade III (n= 14) and grade V (n= 1). Grade I and II (n= 12) biliary complications were successfully managed conservatively. Grade III cases were treated using ultrasound-guided aspiration (USGA), endoscopic retrograde cholangiography (ERCP) and surgery in 10, 2 and 2 donors, respectively. Single donor mortality (Grade V) (0.4%) occurred after uncontrolled biliary leakage with peritonitis that necessitated exploration followed by ERCP with stent insertion but the donor died on day 43 as a result of ongoing sepsis. CONCLUSION: Although the majority of biliary complications are minor and can be managed conservatively, uncontrolled biliary leakage is a serious morbidity that should be avoided as it could lead to mortality.
BACKGROUND: After right lobe donation, biliary complication is the main cause of morbidity. Mortality after right lobe donation has been estimated to be less than 0.5%. PATIENTS AND METHODS: Between November 2001 and December 2008, 207 adult-to-adult living donor liver transplantations (ALDLT) were undertaken using right lobe grafts. Donors included 173 men and 34 women with a mean age of 28.4 +/- 5.2 years. RESULTS: Siblings comprised 144 (69.6%) cases whereas unrelated donors comprised 63 (30.4%) with a mean body mass index (BMI) of 25.2 +/- 2.4. Single and multiple right hepatic ducts (RHD) were present in 82 (39.6%) and 125 (60.3%) donors, respectively. Mean operative time was 360 +/- 50 min with an estimated blood loss of 950 +/- 450 ml and returned cell-saver amount of 450 +/- 334 ml. Mean donor remnant liver volume was 33.5 +/- 3.2%. Mean intensive care unit (ICU) stay was 3 +/- 0.7 days and mean hospital stay was 14 +/- 3.5 days. Modified Clavien classifications were used to stratify all donor biliary complications The overall biliary complications occurred in 27 cases (13.0%). After modified Clavien classification, biliary complications were graded as grade I (n= 10), grade II (n= 2), grade III (n= 14) and grade V (n= 1). Grade I and II (n= 12) biliary complications were successfully managed conservatively. Grade III cases were treated using ultrasound-guided aspiration (USGA), endoscopic retrograde cholangiography (ERCP) and surgery in 10, 2 and 2 donors, respectively. Single donor mortality (Grade V) (0.4%) occurred after uncontrolled biliary leakage with peritonitis that necessitated exploration followed by ERCP with stent insertion but the donor died on day 43 as a result of ongoing sepsis. CONCLUSION: Although the majority of biliary complications are minor and can be managed conservatively, uncontrolled biliary leakage is a serious morbidity that should be avoided as it could lead to mortality.
Authors: M El-Meteini; A Fayez; M Fathy; A Abdalaal; H Safaan; I Mostafa; M Abdalaal; M Syam; R Refay; F Abou-Alfetouh; H Khedr; Y El-Halafawy; Y Taher; H Hamed; S Badawy; A Ryad; H Awad; A Abdallah; T A Ghafar; M El-Monayeri; A Hoballah; A El-Dorry; M Adham; O Boillot Journal: Transplant Proc Date: 2003-11 Impact factor: 1.066
Authors: S Kawasaki; M Makuuchi; H Matsunami; Y Hashikura; T Ikegami; Y Nakazawa; H Chisuwa; M Terada; S Miyagawa Journal: Ann Surg Date: 1998-02 Impact factor: 12.969
Authors: Y Hashikura; M Makuuchi; S Kawasaki; H Matsunami; T Ikegami; Y Nakazawa; K Kiyosawa; T Ichida Journal: Lancet Date: 1994-05-14 Impact factor: 79.321
Authors: T Kiuchi; M Kasahara; K Uryuhara; Y Inomata; S Uemoto; K Asonuma; H Egawa; S Fujita; M Hayashi; K Tanaka Journal: Transplantation Date: 1999-01-27 Impact factor: 4.939
Authors: Michael A Zimmerman; Talia Baker; Nathan P Goodrich; Chris Freise; Johnny C Hong; Sean Kumer; Peter Abt; Adrian H Cotterell; Benjamin Samstein; James E Everhart; Robert M Merion Journal: Liver Transpl Date: 2013-03 Impact factor: 5.799