Clinical Scorecard: Long-Term Outcomes for Individuals Who Donated Liver Portions

At a Glance

Key Highlights

• Living donor liver transplantation addresses deceased donor shortages but donor long-term outcomes remain incompletely understood.
• Biliary complications, including leakage and strictures, are the most frequently reported long-term donor complications.
• Donor mortality is low (0.2% in-hospital), but complication rates range from 15 to 40% in the first year post-donation.

Guideline-Based Recommendations

Diagnosis

• Monitor for early postoperative bile leakage, especially in donors with grafts close to the main bile duct or multiple hepatic arteries.
• Assess for biliary strictures during follow-up, particularly in donors with prior bile leakage.

Management

• Use surgical techniques balancing donor safety and graft volume, favoring left liver grafts and minimally invasive approaches to reduce donor risk.
• Address biliary complications promptly with hospital readmission and invasive procedures as needed.

Monitoring & Follow-up

• Implement long-term follow-up beyond one year to detect persistent biliary complications and other late adverse events.
• Evaluate donor quality of life and physical and psychological health during follow-up.

Risks

• Donor death is rare but devastating; biliary complications can lead to hospital readmissions and additional surgeries.
• Surgical trauma near the main bile duct and extensive dissection for multiple arteries increase risk of bile leakage and ischemic injury.

Patient & Prescribing Data

Living liver donors with partial hepatectomy for LDLT

Donors require informed consent including discussion of potential long-term biliary complications and quality of life impacts; minimally invasive and left graft techniques may improve donor safety.

Clinical Best Practices

• Careful preoperative assessment of biliary anatomy to minimize risk of bile duct injury.
• Preference for left liver grafts and minimally invasive donor hepatectomy when feasible to enhance donor safety.
• Close early postoperative monitoring for bile leakage and strictures with timely intervention.
• Long-term systematic follow-up to monitor and manage late complications and assess donor quality of life.

References

• Strong et al., First successful LDLT in child, 1990
• Hashikura et al., First successful adult LDLT, 1993
• Ruh et al., Risk factors for bile leak in donors
• Berglund et al., Long-term biliary complications incidence
• Lin et al., Lifetime risk of biliary disease post-donation