People considering sharing their liver with an ailing relative or friend can worry a bit less, say doctors who found that living donor liver-transplantation is relatively safe.
The largest North American study to date to look at how people who donate part of their livers fare after the procedure shows almost two in three (62 percent) suffer no complications, reports R. Mark Ghobrial, MD, professor of surgery at UCLA.
And the vast majority of complications that do occur are treatable, he says.
In the study, 2 percent of donors had life-threatening, lasting disabilities. One died of medical complications 21 days after the procedure.
The research was presented here at World Transplant Congress 2006.
Shortage of Donated Livers
There has long been a critical shortage of cadaver livers for transplantation. As of July 4, 2006, more than 17,500 Americans with failing livers were waiting for a new organ, according to the United Network for Organ Sharing. More than 4,000 of them have been waiting five years or longer.
This shortage led to development of living-donor liver transplantation, first performed in the United States in the late 1980s.
In the procedure, a healthy donor -- usually a blood relative -- undergoes an operation to remove a portion of his liver for the recipient.
Part of a blood vessel in the leg is also removed to connect the donated liver portion to the recipient.
The donor may have to remain in the hospital a week or longer as the liver begins to heal and regenerate itself. Full regeneration generally takes six to eight weeks.
Complications, One Death
For the new study, Ghobrial and colleagues collected information on 391 people who underwent living-donor liver transplantation at nine U.S. hospitals between 1998 and 2003. The donors were followed for an average of six months after their surgery.
Average donor age was 37. About two-thirds were biologically related to the recipient.
During the follow-up period, 82 of the total 391 donors suffered one complication; 40 suffered two complications; 16 had three complications; and 10 suffered four to seven complications.
Some of the most common complications were leaks of bile fluid, hernias, and infections. Sixteendonors developed psychologicalproblems requiringtreatment.
Four of the donors died during this period, but only one death could be directly traced to the procedure. Two donors suffered accidental deaths not related to the transplant, and one committed suicide more than a year later.
Reassuring -- or Not?
Researcher James F. Trotter, MD, medical director of liver transplantation at the University of Colorado at Denver, tells WebMD the findings are reassuring.
“There’s been a lot of speculation about the exact number of deaths and complications associated with living-donor transplantation,” says Trotter, a researcher on the study. “The numbers in this study are very similar to those we’ve been quoting to our patients based on clinical experience and smaller studies.”
While some researchers who spoke with WebMD agree with Trotter’s assessment, others took issue.
The complication rates are still too high for comfort, says Ezra Shaharabani, MD, of the Rabin Medical Center in Tel Aviv. “I’d tell a person to think twice about donating a part of their liver [while they’re still alive].”
Your best chance for success? Choose an experienced transplant surgeon at an experienced center -- one who has done at least 20 living donor transplants, Trotter says.
By Charlene Laino, reviewed by Louise Chang, MD
SOURCES: World Transplant Congress 2006, Boston, July 22-27, 2006. R. Mark Ghobrial, MD, professor of surgery, UCLA. James F. Trotter, MD, medical director, liver transplantation, University of Colorado at Denver. Ezra Shaharabani, MD, of the Rabin Medical Center, Tel Aviv. United Network for Organ Sharing (UNOS) web site, “Living Donation Procedures.”