Evaluation of Potential Donors in Living Donor Liver Transplantation A. Dirican, A. Baskiran, M. Dogan, M. Ates*, V. Soyer, B. Sarıcı, F. Ozdemir, Y. Polat, and S. Yilmaz Department of General Surgery and Liver Transplantation Institute, Inonu University, Malatya, Turkey
ABSTRACT Introduction. Correct donor selection in living donor liver transplantation (LDLT) is essential not only to decrease the risks of complications for the donors but also to increase the survival of both the graft and the recipient. Knowing their most frequent reasons of donor elimination is so important for transplantation centers to gain time. In this study we evaluated the effectiveness of potential donors in LDLT and studied the reasons for nonmaturation of potential liver donors at our transplantation center. Patients and Methods. We studied the outcomes of 342 potential living donor candidates for 161 recipient candidates for liver transplantation between January 2013 and June 2014. Donor candidates’ gender, age, body mass index (BMI), relationship with recipient, and causes of exclusion were recorded. Results. Among 161 recipients, 96 had a LDLT and 7 had cadaveric liver transplantation. Twelve of the 342 potential donors did not complete their evaluation; 106 of the remaining 330 donor candidates were accepted as suitable for donation (32%) but 10 of these were excluded preoperatively. The main reasons for unsuitability for liver donation were small remnant liver size (43%) and fatty changes of the liver (38.4%). Other reasons were arterial anatomic variations, ABO incompatibility, and Gilbert syndrome. Only 96 of the candidates (29% of the 330 candidates who completed the evaluation) underwent donation. Effective donors were 29% of potential and 90.5% of suitable donors. Conclusions. In our center, 106 of 330 (32%) donor candidates were suitable for donation and the main reasons for unsuitability for liver donation were small remnant liver size and fatty changes of the liver.
HERE is a disproportion between the increase in liver transplant candidates and cadaveric organ donors, so that the number of patients who die or are excluded from the waiting list for transplantation increases. Alternative treatment modalities have been studied such as living donor liver transplantation (LDLT) . The outcomes improve feasibility of this treatment option and encourage both the recipients and donors. Selection of a suitable donor is very important for successful LDLT. The goal of donor evaluation is to determine whether or not the donor is medically and psychologically suitable for living donation. Donor evaluation is essential not only to decrease the risks of complications for the donors but also to increase the survival of both the graft and the recipient. Therefore, strict donor selection criterias are used for successful LDLT in transplantation clinics. The main causes of donor elimination are changed from center to center. Knowing their most
frequent reason of donor elimination is so important for a transplantation center to gain time during the donor evaluation process. In this study, we evaluated causes of donor elimination and effectiveness of potential donor selection in our transplantation center. PATIENTS AND METHODS We studied the outcomes of 342 potential donor candidates for 161 recipient candidates for liver transplantation between January 2013 and June 2014. Donor candidates’ gender, age, body mass index (BMI), relationship with the recipient, and causes of exclusion were recorded. Donor candidates were divided into accepted and nonaccepted groups. Variables of the 2 groups were compared. *Address correspondence to Mustafa Ates, MD, Department General Surgery, School of Medicine, Inonu University, 44315 Malatya, Turkey. E-mail: [email protected]
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Transplantation Proceedings, 47, 1315e1318 (2015)
Donor Evaluation Donors were limited to recipients within a fourth degree of consanguinity; otherwise, approval was obtained from the ethics committee of the Health Minister for each individual donor-recipient pair. Donor demographics are listed in Table 1. All living donor candidates underwent a psychosocial evaluation to determine whether there was coercion and they truly understood the risks of the procedure by a team that included psychiatrists, psychologists, and psychiatric nurses. After the evaluation, in the case of detection of factors such as ambivalence, guilt, depression, substance abuse, fear of the future due to the economic concerns, and family and environmental pressure, the donor candidate was excluded from the elimination stages. After psychiatric evaluation, donor candidates passed a 3-step elimination system deﬁned by Trotter  (Fig 1) and used in many transplantation centers. The acceptance criteria for living liver donors included age between 18 and 65 years; normal liver, kidney, and hematologic functions; negative results from serological tests for hepatitis B surface antigen and hepatitis C virus (HCV) antibody; and ABO compatibility. In the ﬁrst phase, clinical assessment, laboratory test, and serological tests were applied. All donors were assessed routinely by blood group, complete blood cell count, blood biochemistry values, viral serological panel, and blood and urinary cultures. The donor candidates who were suspected to have cardiac pathologies after laboratory and clinical assessment underwent echocardiography and, when needed, stress electrocardiography. In the second phase, a three-dimensional computed tomography (CT) scan and Doppler ultrasonography were used for graft volumetric analysis and the delineation of the vascular anatomy [3e6]. The liver volume of each donor was calculated by the same radiologist using contrast-enhanced, multi-detector CT according to the Cavalier method. In the third phase, liver biopsy was performed only when the potential donor candidate’s hepatosteatosis was between 5% and 10% at multi-detector CT and the recipient has no other donor candidate. We do not accept candidates as a donor if hepatosteatosis is >5%. The right liver volume was calculated on the basis of the volumetric study and was expressed as the percentage of the total liver volume. The type of donor for the right hepatectomy was determined according to a preoperative CT-based assessment. A graft-to-recipient weight ratio (GRWR) of 0.8% was accepted as the safety limit to avoid small-for-size syndrome in the recipient. Endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiopancreatography (MRCP), and hepatic angiography, which take place in the Trotter’s elimination stages, are not applied routinely in our center.
Statistical Analysis Data retrieved from our transplantation databases were collaborated by medical chart review. Data were reported as mean standard deviation. Categorical data were compared using the Fisher exact test. A probability of