الفهرس 
REVIEW OF LIVER TRANSPLANTATION
Donor Medical HistoryOnly 14 pages are availabe for public view
 |  | from | 133 |  |  |
| | | from | 133 | | |
Abstract
Selection and evaluation of living liver donor for adult recipient is a complicated process involves optimizing graft size in relation to the safety of both donors and recipients, technical details of liver procurement, and ethical problems of using non related live donors (Du et al., 2014).
Donor hepatectomy entails morbidity and mortality risks. Approximately one third of the patients experience some kind of complication, the majority of which are type I or II according to the Clavien-Dindo classification system (Hwang et al., 2006)
Donor safety is the most important clinical issue related to LDLT and all potential living donors should be informed about the risks of surgery (Sevmis et al., 2008).
This study was conducted in Ain Shams Center of Liver Transplantation (ASCOT), in the period from January 2011 to December 2014. We performed this observational study on 123 donors who were recruited for living-donor liver transplantation.
The aim of the current study was to highlight the outcomes of donors after LDLT, possible complications that can occur and also the predictors and possible risk factors of these complications and events.All studied cases were subjected to the following; careful history taking, thorough clinical examination and laboratory investigations [liver enzymes (AST and ALT), serum albumin, INR, total and direct bilirubin, complete blood picture, liver ultrasound & Doppler. Finally, recording any post-operative or interventional management was done. They were followed-up for minimum one month post-operative (1
st, 7th day and before discharge) in order to detect any laboratory abnormalities.
In the present study, among the 123 enrolled donors, there was male predominance 101(82.1%) vs. 22(17.9%) females with mean of age 28.4±7.17 and B.M.I mean of 24.6±2.9. As regards the relation of the donors to the recipients, the results showed that 57.7% were mostly of 1st and 2nd degree relation vs.42.3% were not related to the recipients.
Concerning the pre-operative characteristics of the studied cases, the mean total liver volume was 1543.22 ± 276.39 and the mean of the donated lobe volume was 877.93 ± 183.87. The percentage of the right lobe graft and the left ones were 93.5% (no=115) and 6.5% (no=8) respectively. Left lobe grafts were divided into 3 donors with left lobe (without MHV), 3 with left lateral hepatectomy (segment 2 & 3) and 2 donors with left graft (with MHV).
Regarding the operative characteristics of the studied cases, all donors survived the procedure with mean operative time of 5.74 ± 1.03 hours and mean hospital stay of 20.68 ± 11.0 ranges from (7-79). The intraoperative complications were reported in 29.7% (n=36) where 5 donors had I.V.C tear, another 5 donors had bile duct injuries and 5 other donors had slipped clamp of a vessel.
Around 30% of the studied cases required intraoperative blood transfusion due to intra-operative significant blood loss.
Concerning post operative data, the current study reported that all donors exhibited transient liver enzyme elevation, hyperbilirubinemia, and hypoalbuminemia in the immediate post-operative period. The liver profile of most of the patients whom were not complicated was normalized after a mean of 14 days and the overall complicated cases were 63.4% also with no mortality or grade IV complications.
The post-transplant complications were recorded and revealed that the most common complications were intra-abdominal collections, biliary leak, pleural effusion and bacterial infection with a prevalence of 48%, 43.1%, 40.7% & 38.2%, respectively. So, intra-abdominal collections was the most common post-operative complication representing 48% (n=59); however most of the reported cases (n=55, 86%) were mild and required no medical intervention.In the current study, the most common site of infection was in the intra-abdominal collections with the most common organism was staph. Coagulase negative cocci (No=23, 18.7%).
The present results showed that only two case (1.6%) of the studied cases developed pulmonary embolism, another one (0.8%) developed induced pneumothorax after therapeutic pleural tapping and two cases (1.6%) suffered from intestinal obstruction and surgical exploration was done to relief bowl obstruction.
Also, the current study reported neither post-hepatectomy intra-abdominal bleeding, nor vascular complications (such as portal vein thrombosis (PVT) and hepatic venous obstruction or perioperative donor deaths.
In the present study we divided the included donors into two groups according to the presence of complication to detect any predictors to these complications.
There was no correlation between the preoperative donor characteristics and the donors’ outcomes. But, donors’ complications were non-significantly higher among right lobe donors than left lobe cases.
The current study assessed the potential predictors in the post-operative data which were significantly correlated to the incidence of complications among donors. The early presence of bile in the drain in day (1) was highly significant correlated to the occurrence of complications among donors.
The post-operative day (7) laboratory results were crucial where each of elevated total serum bilirubin level, the presence of fever, presence of infection by documented culture results and high detectable bile level in the drain were highly significant correlated to the occurrence of the complications among donors.
In conclusion, post-operative Day (7) parameters are crucial for donors and can predict their outcomes (total serum bilirubin level, detectable bile in the drain, presence of fever and documented infection by cultures). These parameters have high significant correlation and consider predicting factors for the occurrence of donors’ complications. As well as, the hospital stay more than 18 days has the highest predictive value of complication incidence.