Anesthetic Management and Analysis of Postoperative Morbidity of Donors in Living-Related Liver Transplantation

Choi, Soo Joo; Lee, Sang Ho; Gwak, Mi Sook; Yang, Mi Kyung; Hahm, Tae Soo; Kim, Gaab Soo

Abstract

BACKGROUND: Living liver donor surgery will become more common because of a shortage of donor organs. Howerver, donor hepatectomy has a potentially significant risk to the donor and raises important issues about the safety of the procedure. Our experience in the anesthetic management of donors is discussed and complications encountered are recorded.
METHODS
The charts, anesthetic records and computerized hospital data of 100 consecutive donors for living-related liver transplantations from June 1996 to March 2002 were retrospectively reviewed. Donor characteristics, blood loss, fluids and blood administered, surgical and anesthetic duration, hospital stay time, postoperative complications, and perioperative changes in hemoglobin (Hb), aspartate transferase (AST), alanine transferase (ALT), and prothrombin time (PT) were investigated.
RESULTS
A graft type consisted of 31 left lateral segments, 8 left lobes and 61 right lobes. The average operating time was 401.3+/-79.0 minutes and total duration of hospital stay was 14.1+/-2.6 days. The mean blood loss was 731.3+/-481.2 ml and 9 donors received a transfusion of heterologous packed red blood cells. Seven donors developed postoperative complications, all of which were managed conservatively. The average Hb decreased significantly from a preoperative value of 14.2+/-1.6 g/dl to the lowest postoperative value of 11.6+/-1.5 g/dl. AST, ALT and PT reached their highest level on the first postoperative day and decreased rapidly afterwards. All of these values were significantly different from the preoperative values for the postoperative 30 days.
CONCLUSIONS
Serious complications did not occur after a living donor hepatectomy at our hospital, but the risk to the donor cannot be completely eliminated. Therefore the donor's safety and quality of life as well as graft function should be considered in living donor operation.