Analysis of donor risk in living-donor hepatectomy

The impact of resection type on clinical outcome

Ephrem Salamé, Michael J. Goldstein, Milan Kinkhabwala, Sandip Kapur, Richard Finn, Steven Lobritto, Robert Brown, Jean C. Emond

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

The progressive shortage of liver donors has mandated investigation of living-donor transplantation (LDT). Concerns about increasing risk to the donor are evident, but the impact of the degree of parenchymal loss has not been quantified. We analyzed clinical and biological variables in 45 LDT performed by our team over 2years to assess risks faced in adult LDT. All donors are alive and well with complete follow-up through to February 2001. When the three operations were compared, right hepatectomy (RH) was significantly longer in terms of anesthesia time and blood loss compared with left hepatectomy (LH) and left lobectomy (LL). Donor remnant liver was significantly reduced after RH compared with LH and LL. There were significant functional differences as a consequence of the remnant size, measured by an increase in peak prothrombin time after RH. RH for adults represents a markedly different insult from pediatric donations in terms of parenchymal loss and early functional impairment. Left hepatectomy donation offers modest advantage over right lobes but seems to confer substantial technical risk for a small gain in graft size. Unless novel strategies are developed to enhance liver function of the LH graft in the adult recipient, right lobe donation will be necessary for adult LDT.

Original languageEnglish (US)
Pages (from-to)780-788
Number of pages9
JournalAmerican Journal of Transplantation
Volume2
Issue number8
DOIs
StatePublished - Sep 2002
Externally publishedYes

Fingerprint

Living Donors
Hepatectomy
Tissue Donors
Transplantation
Liver
Transplants
Prothrombin Time
Anesthesia
Pediatrics

Keywords

  • Donor
  • Liver transplant
  • Living-donor
  • Outcome
  • Risk

ASJC Scopus subject areas

  • Immunology

Cite this

Analysis of donor risk in living-donor hepatectomy : The impact of resection type on clinical outcome. / Salamé, Ephrem; Goldstein, Michael J.; Kinkhabwala, Milan; Kapur, Sandip; Finn, Richard; Lobritto, Steven; Brown, Robert; Emond, Jean C.

In: American Journal of Transplantation, Vol. 2, No. 8, 09.2002, p. 780-788.

Research output: Contribution to journalArticle

Salamé, Ephrem ; Goldstein, Michael J. ; Kinkhabwala, Milan ; Kapur, Sandip ; Finn, Richard ; Lobritto, Steven ; Brown, Robert ; Emond, Jean C. / Analysis of donor risk in living-donor hepatectomy : The impact of resection type on clinical outcome. In: American Journal of Transplantation. 2002 ; Vol. 2, No. 8. pp. 780-788.
@article{23d74a33553d4298b9c95287d5598cc7,
title = "Analysis of donor risk in living-donor hepatectomy: The impact of resection type on clinical outcome",
abstract = "The progressive shortage of liver donors has mandated investigation of living-donor transplantation (LDT). Concerns about increasing risk to the donor are evident, but the impact of the degree of parenchymal loss has not been quantified. We analyzed clinical and biological variables in 45 LDT performed by our team over 2years to assess risks faced in adult LDT. All donors are alive and well with complete follow-up through to February 2001. When the three operations were compared, right hepatectomy (RH) was significantly longer in terms of anesthesia time and blood loss compared with left hepatectomy (LH) and left lobectomy (LL). Donor remnant liver was significantly reduced after RH compared with LH and LL. There were significant functional differences as a consequence of the remnant size, measured by an increase in peak prothrombin time after RH. RH for adults represents a markedly different insult from pediatric donations in terms of parenchymal loss and early functional impairment. Left hepatectomy donation offers modest advantage over right lobes but seems to confer substantial technical risk for a small gain in graft size. Unless novel strategies are developed to enhance liver function of the LH graft in the adult recipient, right lobe donation will be necessary for adult LDT.",
keywords = "Donor, Liver transplant, Living-donor, Outcome, Risk",
author = "Ephrem Salam{\'e} and Goldstein, {Michael J.} and Milan Kinkhabwala and Sandip Kapur and Richard Finn and Steven Lobritto and Robert Brown and Emond, {Jean C.}",
year = "2002",
month = "9",
doi = "10.1034/j.1600-6143.2002.20813.x",
language = "English (US)",
volume = "2",
pages = "780--788",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "8",

}

TY - JOUR

T1 - Analysis of donor risk in living-donor hepatectomy

T2 - The impact of resection type on clinical outcome

AU - Salamé, Ephrem

AU - Goldstein, Michael J.

AU - Kinkhabwala, Milan

AU - Kapur, Sandip

AU - Finn, Richard

AU - Lobritto, Steven

AU - Brown, Robert

AU - Emond, Jean C.

PY - 2002/9

Y1 - 2002/9

N2 - The progressive shortage of liver donors has mandated investigation of living-donor transplantation (LDT). Concerns about increasing risk to the donor are evident, but the impact of the degree of parenchymal loss has not been quantified. We analyzed clinical and biological variables in 45 LDT performed by our team over 2years to assess risks faced in adult LDT. All donors are alive and well with complete follow-up through to February 2001. When the three operations were compared, right hepatectomy (RH) was significantly longer in terms of anesthesia time and blood loss compared with left hepatectomy (LH) and left lobectomy (LL). Donor remnant liver was significantly reduced after RH compared with LH and LL. There were significant functional differences as a consequence of the remnant size, measured by an increase in peak prothrombin time after RH. RH for adults represents a markedly different insult from pediatric donations in terms of parenchymal loss and early functional impairment. Left hepatectomy donation offers modest advantage over right lobes but seems to confer substantial technical risk for a small gain in graft size. Unless novel strategies are developed to enhance liver function of the LH graft in the adult recipient, right lobe donation will be necessary for adult LDT.

AB - The progressive shortage of liver donors has mandated investigation of living-donor transplantation (LDT). Concerns about increasing risk to the donor are evident, but the impact of the degree of parenchymal loss has not been quantified. We analyzed clinical and biological variables in 45 LDT performed by our team over 2years to assess risks faced in adult LDT. All donors are alive and well with complete follow-up through to February 2001. When the three operations were compared, right hepatectomy (RH) was significantly longer in terms of anesthesia time and blood loss compared with left hepatectomy (LH) and left lobectomy (LL). Donor remnant liver was significantly reduced after RH compared with LH and LL. There were significant functional differences as a consequence of the remnant size, measured by an increase in peak prothrombin time after RH. RH for adults represents a markedly different insult from pediatric donations in terms of parenchymal loss and early functional impairment. Left hepatectomy donation offers modest advantage over right lobes but seems to confer substantial technical risk for a small gain in graft size. Unless novel strategies are developed to enhance liver function of the LH graft in the adult recipient, right lobe donation will be necessary for adult LDT.

KW - Donor

KW - Liver transplant

KW - Living-donor

KW - Outcome

KW - Risk

UR - http://www.scopus.com/inward/record.url?scp=0036766477&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036766477&partnerID=8YFLogxK

U2 - 10.1034/j.1600-6143.2002.20813.x

DO - 10.1034/j.1600-6143.2002.20813.x

M3 - Article

VL - 2

SP - 780

EP - 788

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 8

ER -