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Long-Term Follow-Up After Right Hepatectomy for Adult Living Donation and Attitudes Toward the Procedure

Sotiropoulos, Georgios C. MD, FACS*; Radtke, Arnold MD; Molmenti, Ernesto P. MD, MBA, FACS; Schroeder, Tobias MD§; Baba, Hideo A. MD; Frilling, Andrea MD, FACS**; Broelsch, Christoph E. MD, FACS††; Malagó, Massimo MD‡‡

doi: 10.1097/SLA.0b013e31823594ae
Original Article From the ESA Proceedings

Objectives: To determine the long-term health status of donors after right hepatectomy for adult live donor liver transplantation (ALDLT).

Background: The long-term outcomes for ALDLT donors are unknown.

Methods: ALDLT donors undergoing right hepatectomy from April 1998 to June 2007 were invited to complete a questionnaire regarding health status, satisfaction (1–10/worst–best scale), self-esteem, willingness to donate again, and suggestions for improvement. In addition, donor files and cholecystectomy specimens were reviewed. Fisher's exact test, Kaplan-Meier and logistic regression analyses were performed.

Results: Eighty-three donors were contacted (median age: 36 years; median follow-up: 69 months). 39 (47%) were free of symptoms. The remaining 44 (53%) reported: intolerance to fatty meals and diarrhea (31%), gastroesophageal reflux associated with left liver hypertrophy (9%), incisional discomfort requiring pain medications (6%), severe depression requiring hospitalization (4%), rib pain affecting lifestyle (2%), and exacerbation of psoriasis (1%). Median satisfaction score was 8. Self-esteem diminished in 5%. Thirty-nine (47%) recommended improvements particularly more detailed informed donor consent and a centralized living donor liver registry. Seventy-eight (94%) were willing to donate again. There were no differences between donors with and without complaints with respect to: donor age, gender, early complications and follow-up time, young-to-old donation, recipient diagnosis of malignancy and death of the recipient. Noninflamed donor cholecystectomy specimens correlated with intolerance to fatty meals and diarrhea (P = 0.001).

Conclusions: ALDLT donors are at risk for long-term complaints that are neither reflected nor related to early complications. This information should be included in both the donor evaluation and the ALDLT decision-making process.

A standardized approach to live liver donor evaluation and follow-up is emphasized. Although up to 50% of candidates have long-term complaints, 94% would still volunteer again for the procedure.

*Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Germany;

Department of General and Thorax Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany;

Department of Surgery, North Shore University Hospital, Manhasset, New York;

§Department of Diagnostic and Interventional Radiology;

Institute for Pathology and Neuropathology, University Hospital Essen, Germany;

**Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, UK;

††Professor Emeritus;

‡‡Department of Surgery-UCL Division of Surgical and Interventional Sciences, University College London, Royal Free Hospital, London, UK.

Reprints: Prof. Dr. Georgios C. Sotiropoulos, FACS, FEBS, Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany. E-mail:

Disclosure: No financial support or funding to declare.

© 2011 Lippincott Williams & Wilkins, Inc.