Posthepatectomy postoperative evolution in the context of a liver transplantation by living donation. Twenty years of experience at Cliniques universitaires Saint-Luc

Details

Supervisors

Bonaccorsi-Riani, Eliano

Faculty

Faculté de médecine et médecine dentaire

Degree label

Master [180] en médecine

Abstract

Data of 64 donors having undergone living donor liver transplantation at Cliniques universitaires Saint-Luc were analysed in order to gain perspective on postoperative evolution by collecting retrospective laboratory, radiology and clinical data. Psychosocial aspects were evaluated with three surveys. The influence of type of graft on the outcome was also analysed. Significant differences were found in total bilirubin (p = 0.023) and INR (p = 0.0008) values between the right and left liver donors. At one year, platelets remained lower than baseline values in both groups. The remaining liver volume was significantly smaller in right liver donors (p <0.0001) with a more intense hepatic regeneration. Various radiological anomalies were observed in most of the patients, although the vast majority of these were temporary and did not require any therapeutic intervention. The only significant difference concerned blood vessel abnormalities (p = 0.0184) and perfusion disorders (p = 0.0032), which occurred more frequently in left liver donors. Postoperative complications occurred in 62.5% of the patients, 7.8% being Clavien-Dindo grade IIIA, 7.8% grade IIIB and one patient grade IVA. There was no significant difference in complication rates between the two groups. SF-36 survey showed no significant difference from a German liver donor population, except in Physical functioning where Saint-Luc donors scored higher (p = 0.0405). Compared to the Norwegian general population, Saint-Luc donors scored significantly higher in Physical functioning (p = 0.0237) but lower in Emotional well-being (p = 0.0014). Significantly higher results were observed in all categories except for Emotional well-being (p = 0.9653) in comparison to the Medical Outcomes Study population. EULID survey results showed that donors were globally satisfied with the donation process and all would undergo the procedure again. However, financial loss due to the donation was stated by 26%. Complementary questions showed that the donation had almost no impact on change of civil status. The donation did not cause any changes in life for two thirds of the donors. In order to improve the donors' experience, more attention could be paid to the care of the donor during hospitalisation since 8% did not feel well taken care of. Nevertheless, these results show that living liver donation is a relatively safe option for liver transplantation with no clinical differences between right and left liver donors.