An analysis of the surgical and perioperative complications in right hepatectomies

Adult living related liver donors play an essential role in filling the gap of transplants needed due to a heavy shortage of cadaveric donations. Considering that living related donors are healthy individuals at baseline, it is imperative to ensure good outcomes and return to quality of life.

A research article to be published on 28 May 2008, in the World Journal of Gastroenterology addresses this question. The research team led by Prof. Salvatore Gruttadauria from Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione designed an accurate, comprehensive step-by-step work-up protocol for donor evaluation to ensure donor safety and to confirm that the donor is capable of providing a suitable graft.

The strategy of careful evaluation of the living donor performed by an interdisciplinary team cannot be overemphasized. Their research has proven the necessity of evaluating the overall health of both the donor and recipient at many different levels from biopsy to body mass index. Their research has indicated liver biopsy in the exclusion of potential donors otherwise considered fit to donate. These biopsies assess the quality of the donation to ensure the likelihood of success of the transplant and the health of both the donor and the recipient.

Authors' experience shows that heavier donors, when subjected to an exercise and diet program, all return to previous activity. In fact, no life threatening complications, long term impairments, or deaths have occurred in these donors.

With all of this in mind, the study was designed to evaluate operative complications in a series of seventy five patients. In heir series, 30.6% of living donors developed a complication in the perioperative period. Complications related to biliary tree reconstruction (9.33%) were the most common, although no patients had to undergo repeated open surgery. None of the 75 live donors in the series, regardless of their post-operative course, manifested any regrets about live donation.

In conclusion, the study reports the largest Italian experience on right hepatic liver donation, focused on perioperative complications and on donor safety, which must be the first priority. The need to define, categorize and record complications when healthy individuals, such as living donors, undergo a major surgical procedure like a right hepatectomy reflects the need for prompt and detailed reports of complications arising in this particular category of patient.

Reference: Gruttadauria S, Marsh JW, Vizzini GB, di Francesco F, LucaA, Volpes R, Marcos A, Gridelli B. Analysis of surgical and perioperative complications in seventy-five right hepatectomies for living donor liver transplantation. World J Gastroenterol 2008; 14(20): 3159-3164:
http://www.wjgnet.com/1007-9327/14/3159.asp

Correspondence to: Salvatore Gruttadauria, MD, Department of Abdominal Transplant Surgery, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, Palermo 90127, Italy. sgruttadauria@ismett.edu
Telephone: +39-91-2192111 Fax: +39-91-2192400

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.