TY - JOUR
T1 - Donor safety in living donor liver donation: An Italian multicenter survey.
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.
U2 - 10.1002/lt.24651
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 -