Donor safety in living donor liver donation: An Italian multicenter survey.

Andrea Lauterio, Stefano Di Sandro, Salvatore Gruttadauria, Marco Spada, Fabrizio Di Benedetto, Umberto Baccarani, Enrico Regalia, Ernesto Melada, Alessandro Giacomoni, Matteo Cescon, Davide Cintorino, Giorgio Ercolani, Matteo Rota, Giorgio Rossi, Vincenzo Mazzaferro, Andrea Risaliti, Daniele Antonio Pinna, Bruno Gridelli, Luciano De Carlis

Research output: Contribution to journalArticle

Abstract

Major concerns about donor morbidity and mortality still limit the use of living donor liver transplantation (LDLT) to overcome the organ shortage. The present study assessed donor safety in LDLT in Italy reporting donor postoperative outcomes in 246 living donation procedures performed by 7 transplant centers. Outcomes were evaluated over 2 time periods using the validated Clavien 5-tier grading system, and several clinical variables were analyzed to determine the risk factors for donor morbidity. Different grafts were obtained from the 246 donor procedures (220 right lobe, 10 left lobe, and 16 left lateral segments). The median follow-up after donation was 112 months. There was no donor mortality. One or more complications occurred in 82 (33.3 donors, and 3 of them had intraoperative complications (1.2. Regardless of graft type, the rate of major complications (grade textgreater/= 3) was 12.6% (31/246). The overall donor morbidity and the rate of major complications did not differ significantly over time: 26 (10.6 donors required hospital readmission throughout the follow-up period, whereas 5 (2.0 donors required reoperation. Prolonged operative time (textgreater400 minutes), intraoperative hypotension (systolic textless 100 mm Hg), vascular abnormalities, and intraoperative blood loss (textgreater300 mL) were multivariate risk factors for postoperative donor complications. In conclusion, from the standpoint of living donor surgery, a meticulous and well-standardized technique that reduces operative time and prevents blood loss and intraoperative hypotension may reduce the incidence of donor complications. Transparency in reporting results after LDLT is mandatory, and we should continue to strive for zero donor mortality. Liver Transplantation 23 184-193 2017 AASLD.
Original languageUndefined/Unknown
Pages (from-to)184-193
Number of pages10
JournalLiver Transplantation
Volume23
Issue number2
DOIs
Publication statusPublished - Feb 1 2017

Cite this

Lauterio, A., Di Sandro, S., Gruttadauria, S., Spada, M., Di Benedetto, F., Baccarani, U., ... Carlis, L. D. (2017). Donor safety in living donor liver donation: An Italian multicenter survey. Liver Transplantation, 23(2), 184-193. https://doi.org/10.1002/lt.24651

Donor safety in living donor liver donation: An Italian multicenter survey. / Lauterio, Andrea; Di Sandro, Stefano; Gruttadauria, Salvatore; Spada, Marco; Di Benedetto, Fabrizio; Baccarani, Umberto; Regalia, Enrico; Melada, Ernesto; Giacomoni, Alessandro; Cescon, Matteo; Cintorino, Davide; Ercolani, Giorgio; Rota, Matteo; Rossi, Giorgio; Mazzaferro, Vincenzo; Risaliti, Andrea; Pinna, Daniele Antonio; Gridelli, Bruno; Carlis, Luciano De.

In: Liver Transplantation, Vol. 23, No. 2, 01.02.2017, p. 184-193.

Research output: Contribution to journalArticle

Lauterio, A, Di Sandro, S, Gruttadauria, S, Spada, M, Di Benedetto, F, Baccarani, U, Regalia, E, Melada, E, Giacomoni, A, Cescon, M, Cintorino, D, Ercolani, G, Rota, M, Rossi, G, Mazzaferro, V, Risaliti, A, Pinna, DA, Gridelli, B & Carlis, LD 2017, 'Donor safety in living donor liver donation: An Italian multicenter survey.', Liver Transplantation, vol. 23, no. 2, pp. 184-193. https://doi.org/10.1002/lt.24651
Lauterio, Andrea ; Di Sandro, Stefano ; Gruttadauria, Salvatore ; Spada, Marco ; Di Benedetto, Fabrizio ; Baccarani, Umberto ; Regalia, Enrico ; Melada, Ernesto ; Giacomoni, Alessandro ; Cescon, Matteo ; Cintorino, Davide ; Ercolani, Giorgio ; Rota, Matteo ; Rossi, Giorgio ; Mazzaferro, Vincenzo ; Risaliti, Andrea ; Pinna, Daniele Antonio ; Gridelli, Bruno ; Carlis, Luciano De. / Donor safety in living donor liver donation: An Italian multicenter survey. In: Liver Transplantation. 2017 ; Vol. 23, No. 2. pp. 184-193.
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abstract = "Major concerns about donor morbidity and mortality still limit the use of living donor liver transplantation (LDLT) to overcome the organ shortage. The present study assessed donor safety in LDLT in Italy reporting donor postoperative outcomes in 246 living donation procedures performed by 7 transplant centers. Outcomes were evaluated over 2 time periods using the validated Clavien 5-tier grading system, and several clinical variables were analyzed to determine the risk factors for donor morbidity. Different grafts were obtained from the 246 donor procedures (220 right lobe, 10 left lobe, and 16 left lateral segments). The median follow-up after donation was 112 months. There was no donor mortality. One or more complications occurred in 82 (33.3 donors, and 3 of them had intraoperative complications (1.2. Regardless of graft type, the rate of major complications (grade textgreater/= 3) was 12.6{\%} (31/246). The overall donor morbidity and the rate of major complications did not differ significantly over time: 26 (10.6 donors required hospital readmission throughout the follow-up period, whereas 5 (2.0 donors required reoperation. Prolonged operative time (textgreater400 minutes), intraoperative hypotension (systolic textless 100 mm Hg), vascular abnormalities, and intraoperative blood loss (textgreater300 mL) were multivariate risk factors for postoperative donor complications. In conclusion, from the standpoint of living donor surgery, a meticulous and well-standardized technique that reduces operative time and prevents blood loss and intraoperative hypotension may reduce the incidence of donor complications. Transparency in reporting results after LDLT is mandatory, and we should continue to strive for zero donor mortality. Liver Transplantation 23 184-193 2017 AASLD.",
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AU - Lauterio, Andrea

AU - Di Sandro, Stefano

AU - Gruttadauria, Salvatore

AU - Spada, Marco

AU - Di Benedetto, Fabrizio

AU - Baccarani, Umberto

AU - Regalia, Enrico

AU - Melada, Ernesto

AU - Giacomoni, Alessandro

AU - Cescon, Matteo

AU - Cintorino, Davide

AU - Ercolani, Giorgio

AU - Rota, Matteo

AU - Rossi, Giorgio

AU - Mazzaferro, Vincenzo

AU - Risaliti, Andrea

AU - Pinna, Daniele Antonio

AU - Gridelli, Bruno

AU - Carlis, Luciano De

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Major concerns about donor morbidity and mortality still limit the use of living donor liver transplantation (LDLT) to overcome the organ shortage. The present study assessed donor safety in LDLT in Italy reporting donor postoperative outcomes in 246 living donation procedures performed by 7 transplant centers. Outcomes were evaluated over 2 time periods using the validated Clavien 5-tier grading system, and several clinical variables were analyzed to determine the risk factors for donor morbidity. Different grafts were obtained from the 246 donor procedures (220 right lobe, 10 left lobe, and 16 left lateral segments). The median follow-up after donation was 112 months. There was no donor mortality. One or more complications occurred in 82 (33.3 donors, and 3 of them had intraoperative complications (1.2. Regardless of graft type, the rate of major complications (grade textgreater/= 3) was 12.6% (31/246). The overall donor morbidity and the rate of major complications did not differ significantly over time: 26 (10.6 donors required hospital readmission throughout the follow-up period, whereas 5 (2.0 donors required reoperation. Prolonged operative time (textgreater400 minutes), intraoperative hypotension (systolic textless 100 mm Hg), vascular abnormalities, and intraoperative blood loss (textgreater300 mL) were multivariate risk factors for postoperative donor complications. In conclusion, from the standpoint of living donor surgery, a meticulous and well-standardized technique that reduces operative time and prevents blood loss and intraoperative hypotension may reduce the incidence of donor complications. Transparency in reporting results after LDLT is mandatory, and we should continue to strive for zero donor mortality. Liver Transplantation 23 184-193 2017 AASLD.

AB - Major concerns about donor morbidity and mortality still limit the use of living donor liver transplantation (LDLT) to overcome the organ shortage. The present study assessed donor safety in LDLT in Italy reporting donor postoperative outcomes in 246 living donation procedures performed by 7 transplant centers. Outcomes were evaluated over 2 time periods using the validated Clavien 5-tier grading system, and several clinical variables were analyzed to determine the risk factors for donor morbidity. Different grafts were obtained from the 246 donor procedures (220 right lobe, 10 left lobe, and 16 left lateral segments). The median follow-up after donation was 112 months. There was no donor mortality. One or more complications occurred in 82 (33.3 donors, and 3 of them had intraoperative complications (1.2. Regardless of graft type, the rate of major complications (grade textgreater/= 3) was 12.6% (31/246). The overall donor morbidity and the rate of major complications did not differ significantly over time: 26 (10.6 donors required hospital readmission throughout the follow-up period, whereas 5 (2.0 donors required reoperation. Prolonged operative time (textgreater400 minutes), intraoperative hypotension (systolic textless 100 mm Hg), vascular abnormalities, and intraoperative blood loss (textgreater300 mL) were multivariate risk factors for postoperative donor complications. In conclusion, from the standpoint of living donor surgery, a meticulous and well-standardized technique that reduces operative time and prevents blood loss and intraoperative hypotension may reduce the incidence of donor complications. Transparency in reporting results after LDLT is mandatory, and we should continue to strive for zero donor mortality. Liver Transplantation 23 184-193 2017 AASLD.

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DO - 10.1002/lt.24651

M3 - Articolo

VL - 23

SP - 184

EP - 193

JO - Liver Transplantation

JF - Liver Transplantation

SN - 1527-6465

IS - 2

ER -