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Hepatology International

, Volume 12, Issue 1, pp 67–74 | Cite as

“No go” donor hepatectomy in living-donor liver transplantation

  • Viniyendra Pamecha
  • Kishore G. S. Bharathy
  • Shyam S. Mahansaria
  • Piyush K. Sinha
  • Archana Rastogi
  • Shridhar V. Sasturkar
Original Article

Abstract

Background

Selection of appropriate donors after rigorous evaluation is of paramount importance in living-donor liver transplantation. Despite this, donor surgery may not proceed due to unforeseen reasons. The aim of this paper is to study reasons for “no go” donor hepatectomy in living liver donors.

Patients and methods

Donor operations stopped after surgical start, directly due to donor safety-related reasons, qualified for inclusion as “no go” donor hepatectomy. Living-donor evaluation was performed as per standard protocol. Data for consecutive living liver donors operated between April 2012 and November 2016 were analyzed to evaluate reasons for “no go” donor hepatectomy in a liver transplantation unit at a tertiary care teaching hospital.

Results

In 307 donors, the operation was aborted in 7 (2.3 %). One patient had unexpected biliary pathology with fibrosis found intraoperatively. Operations in five donors were abandoned in view of liver parenchymal abnormalities (fibrosis/steatohepatitis). One donor had hemodynamically significant bradycardia after handling the round ligament. All these donors recovered uneventfully and remained well on follow-up.

Conclusions

“No go” donor hepatectomy remains a real possibility despite rigorous assessment. Although thresholds for on-table rejection of the donor after complete evaluation vary, “no go” hepatectomy is a calculated risk-avoidance approach.

Keywords

Donor selection Living-donor liver transplantation Outcome Living-donor safety 

Abbreviations

LDLT

Living-donor liver transplantation

LLD

Live liver donor

BMI

Body mass index

LFT

Liver function tests

CT

Computed tomography

LAI

Liver attenuation index

MRCP

Magnetic resonance cholangiopancreatography

MHV

Middle hepatic vein

HE

Hematoxylin–eosin

MT

Masson’s trichrome

DDLT

Deceased-donor liver transplantation

Notes

Funding

Authors did not receive any funding/grants for this work.

Author contributions

Study conception: Viniyendra Pamecha; manuscript drafting: Shyam Sunder Mahansaria, Kishore GS Bharathy; data collection: Piyush Kumar Sinha, Shridhar Vasantrao Sasturkar; critical revision of the manuscript for important intellectual content: Viniyendra Pamecha, Archana Rastogi, Kishore GS Bharathy.

Compliance with ethical standards

Conflict of interest

Viniyendra Pamecha, Kishore G. S. Bharathy, Shyam S. Mahansaria, Piyush K. Sinha, Archana Rastogi and Shridhar V. Sasturkar have no conflicts of interest to disclose.

Ethical standard

All authors declare no potential conflicts of interest, financial or otherwise. The study is in accordance with the 1964 Helsinki Declaration and approved by the Institute’s review board and ethics committee. Standard protocol was followed in clinical management, and informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Pamecha V, Mahansaria SS, Bharathy KG, Kumar S, Sasturkar SV, Sinha PK, et al. Selection and outcome of the potential live liver donor. Hepatol Int. 2016;10:657–64.CrossRefPubMedGoogle Scholar
  2. 2.
    Shiffman ML, Brown RS, OlthoffKM Everson G, Miller C, Siegler M, et al. Living donor liver transplantation: summary of a conference at The National Institutes of Health. Liver Transpl. 2002;8:174–88.CrossRefPubMedGoogle Scholar
  3. 3.
    Guba M, Adcock L, MacLeod C, Cattral M, Greig P, Levy G, et al. Intraoperative “no go” donor hepatectomies in living donor liver transplantation. Am J Transplant. 2010;10:612–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Lei JY, Yan LN. Intraoperative “no go” donor hepatectomy in living donor liver transplantation. Transplant Proc. 2013;45:2253–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Basaran C, Agildere AM, Donmez FY, Sevmis S, Budakoglu I, Karakayali H, et al. MR cholangiopancreatography with T2-weighted prospective acquisition correction turbo spin-echo sequence of the biliary anatomy of potential living liver transplant donors. AJR Am J Roentgenol. 2008;190:1527–33.CrossRefPubMedGoogle Scholar
  6. 6.
    Song GW, Lee SG, Hwang S, Sung GB, Park KM, Kim KH, et al. Preoperative evaluation of biliary anatomy of donor in living donor liver transplantation by conventional non enhanced magnetic resonance cholangiography. Transpl Int. 2007;20:167–73.CrossRefPubMedGoogle Scholar
  7. 7.
    Ragab A, Lopez-Soler RI, Oto A, Testa G. Correlation between 3D-MRCP and intra-operative findings in right liver donors. Hepatobiliary Surg Nutr. 2013;2:7–13.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Pamecha V, Bharathy KG, Kumar S, Sasturkar SV, Sinha PK. Biliary complications after living donor hepatectomy: a first report from India. Liver Transpl. 2016;22:607–14.CrossRefPubMedGoogle Scholar
  9. 9.
    Simpson MA, Verbesey JE, Khettry U, Morin DS, Gordon FD, Burns DL, et al. Successful algorithm for selective liver biopsy in the right hepatic lobe live donor (RHLD). Am J Transplant. 2008;8:832–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Herrero JI, Rotellar F, Benito A, Sola I, D’Avola D, Marti P, et al. Is liver biopsy necessary in the evaluation of a living donor for liver transplantation? Transplant Proc. 2014;46:3082–3.CrossRefPubMedGoogle Scholar
  11. 11.
    Jun MJ, Shim JH, Kim SY, Seo N, Kim KM, Lim YS, et al. Clinical implications of preoperative and intraoperative liver biopsies for evaluating donor steatosis in living related liver transplantation. Liver Transpl. 2014;20:437–45.CrossRefPubMedGoogle Scholar
  12. 12.
    Hegab B, Abdelfattah MR, Azzam A, Mohamed H, Al Hamoudi W, Alkhail FA, et al. Day-of-surgery rejection of donors in living donor liver transplantation. World J Hepatol. 2012;4:299–304.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Hwang S, Lee SG, Lee YJ, Sung KB, Park KM, Kim KH, et al. Lesson learned from 1,000 living donor liver transplantations in a single center: how to make living donations safe. Liver Transpl. 2006;12:920–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Vij V, Ramaswamy VK, Goja S, Dargan P, Mallya A, Goyal N, et al. Intraoperative “no go” donor hepatectomy in living donor liver transplantation. Am J Transplant. 2010;10:2181–2.CrossRefPubMedGoogle Scholar
  15. 15.
    Ghobrial RM, Freise CE, Trotter JF, Tong L, Ojo AO, Fair JH, et al. A2ALL Study Group. Donor morbidity after living donation for liver transplantation. Gastroenterology. 2008;135:468–76.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Bharathy KGS, Kumar S, Pandey V, Sinha PK, Sasturkar SV, Pamecha V. Re-expansion pulmonary oedema: an unusual and unsettling complication. ANZ J Surg. 2017;87:638–9.CrossRefPubMedGoogle Scholar

Copyright information

© Asian Pacific Association for the Study of the Liver 2017

Authors and Affiliations

  • Viniyendra Pamecha
    • 1
  • Kishore G. S. Bharathy
    • 1
  • Shyam S. Mahansaria
    • 1
  • Piyush K. Sinha
    • 1
  • Archana Rastogi
    • 2
  • Shridhar V. Sasturkar
    • 1
  1. 1.Department of Liver Transplantation and HPB SurgeryInstitute of Liver and Biliary SciencesNew DelhiIndia
  2. 2.Department of PathologyInstitute of Liver and Biliary SciencesNew DelhiIndia

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