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Analysis of donor morbidity in 177 donor hepatectomies for living donor liver transplant: Experience from a high-volume centre in western India

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Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Living donor liver transplant (LDLT) is based on the principle of double equipoise. Organ shortage in Asian countries has led to development of high-volume LDLT programs with good outcomes. Safety of live liver donor is the Achilles heel of LDLT program and every effort should be made to achieve low morbidity and near zero mortality rates.

Methods

We retrospectively analyzed our prospectively maintained donor morbidity data (outcomes) of 177 donors in a new transplant program setup in western India by an experienced surgeon. The primary end point was to analyze the morbidity rates and the factors associated with it.

Results

None of the donors in our cohort of 177 donors developed grade IV or V complication (Clavien-Dindo classification). One-fourth (1/4th) of the donors developed complications ranging from grade I to grade III(b). The rate of complications according to modified Clavien-Dindo classification is as follows: (1) grade I in 5.6% (n = 10), (2) grade II in 14.6% (n = 26), (3) grade III(a) in 3.9% (n = 7), (4) grade III(b) in 2.2% (n = 4). Three donors (1.6%) developed post-hepatectomy intra-abdominal bleeding and required re-exploration (grade IIIb). All of them recovered well post-surgery and are doing well in follow-up. The mean follow-up of the entire cohort was 2871 ± 521 days (range 1926–3736 days).

Conclusion

Donor safety (outcome) is determined by meticulous donor surgery and good-quality remnant.

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Authors and Affiliations

  1. Department of Liver Transplant and HPB Surgery, Apollo Hospitals, Plot No 13, Parsik Hill Road, Off Uran Road, Sector-23, CBD Belapur, Navi Mumbai, 400 614, India

    Shailesh Sable

  2. Department of Liver Transplant and HPB Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, 400 053, India

    Shailesh Sable

  3. Department of Liver Transplant and HPB Surgery, Max Super Specialty Hospital, Vaishali, New Delhi, 201 012, India

    Vibha Varma

  4. Division of Abdominal Transplant, The University of North Carolina, Chapel Hill, NC, USA

    Sorabh Kapoor

  5. Department of Gastroenterology, B. J. Wadia Hospital, Mumbai, 400 012, India

    Samriddhi Poyekar

  6. Department of Liver Transplant and HBP Surgery, Medical Superspeciality Hospital, Kolkata, 734 011, India

    Barun Nath

  7. Department of Surgery (Transplant), Hume Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA

    Vinay Kumaran

Authors
  1. Shailesh Sable
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  2. Vibha Varma
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  5. Barun Nath
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Contributions

Shailesh Sable: conception and design of study, acquisition of data, analysis and/or interpretation of data, drafting the manuscript, revising the manuscript critically for important intellectual content; Vibha Varma: analysis and/or interpretation of data, revising the manuscript critically for important intellectual content; Sorabh Kapoor: analysis and/or interpretation of data, revising the manuscript critically for important intellectual content; Samriddhi Poyekar: acquisition of data, analysis and/or interpretation of data; Barun Nath: acquisition of data, analysis and/or interpretation of data; Vinay Kumaran: revising the manuscript critically for important intellectual content.

Corresponding author

Correspondence to Shailesh Sable.

Ethics declarations

Since analysis and publication of this data does not involve any intervention and since the data has been kept anonymous, the Institutional Review Board waived the requirement of review by the full committee.

Conflict of interest

SS, VV, SK, SP, BN and VK declare that they have no conflict of interest.

Ethics statement

The study was performed conforming to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

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Highlights

1. Donor morbidity rates are very low (no mortality) from a large volume centre in western India.

2. Good quality remnant (30% and more) with meticulous donor hepatectomy is critical for reducing the donor morbidity and mortality.

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Sable, S., Varma, V., Kapoor, S. et al. Analysis of donor morbidity in 177 donor hepatectomies for living donor liver transplant: Experience from a high-volume centre in western India. Indian J Gastroenterol (2024). https://doi.org/10.1007/s12664-024-01552-y

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