Published online before print December 29, 2003, 10.1148/radiol.2302021318
(Radiology 2004;230:443-449.)
© RSNA, 2003
Vascular and Interventional Radiology |
Living Donor Liver Transplantation: Complications in Donors and Interventional Management1
Sun Young Lee, MD,
Gi-Young Ko, MD,
Dong Il Gwon, MD,
Ho-Young Song, MD,
Seung Gyu Lee, MD,
Hyun-Ki Yoon, MD and
Kyu-Bo Sung, MD
1 From the Departments of Radiology (S.Y.L., G.Y.K., D.I.G., H.Y.S., H.K.Y., K.B.S.) and Surgery (S.G.L.), Asan Medical Center, University of Ulsan College of Medicine, 388–1 Poongnap-2-Dong, Songpa-Ku, Seoul 138–736, Korea. Received October 12, 2002; revision requested, December 23; final revision received, June 17, 2003; accepted July 15. Address correspondence to G.Y.K. (e-mail: kogy @amc.seoul.kr)
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ABSTRACT
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PURPOSE: To evaluate the incidence of postoperative complications in liver donors and the efficacy of interventional management for treating these complications.
MATERIALS AND METHODS: The study included 386 consecutive donors: 219 donors underwent right lobectomy or segmentectomy and 167 donors underwent left lobectomy or segmentectomy. Postoperative status, laboratory data, and radiologic images were reviewed for postoperative complications. Interventional management consisted of percutaneous drainage, ultrasonographic (US)-guided aspiration, percutaneous transhepatic biliary drainage (PTBD) and balloon dilation, transcatheter arterial embolization, or portal vein stent placement. Technical success, clinical improvement, and complications were documented following intervention.
RESULTS: In 52 (13.5%) donors, 56 postoperative complications were encountered, including pleural effusion (n = 9), biliary leakage (n = 6), biliary obstruction (n = 5), intraperitoneal abscess (n = 5), active bleeding (n = 5), portal vein stenosis or kink (n = 3), biloma (n = 2), and other complications (n = 21). Complications occurred in 41 (18.9%) right lobe and 11 (7.0%) left lobe donors (P < .001). Twenty-seven (48%) complications were treated with interventional management (percutaneous drainage, n = 10; US-guided aspiration, n = 6; PTBD and balloon dilation, n = 4; transcatheter arterial embolization, n = 4; and stent placement, n = 3) and resolved completely. No procedure-related complications occurred. In one donor with venous oozing, arteriographic images did not show an active bleeding focus; thus, bleeding control with interventional management failed. The remaining 29 complications were treated using medical (n = 27) or surgical (n = 2) management. One donor with acute renal failure has thus far been treated with hemodialysis.
CONCLUSION: Although complications from liver donation are not uncommon, most are minor and, with medical or interventional management, have no long-term sequelae. Interventional management seems useful in the treatment of postoperative complications of liver donation.
© RSNA, 2003
Index terms: Interventional procedures, utilization • Liver, interventional procedures, 761.126 • Liver, transplantation, 761.45 • Surgery, complications, 761.458
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INTRODUCTION
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The severe shortage of cadaveric livers caused by the social customs in Asian countries has resulted in an increasing acceptance of living donor liver transplantation. Despite the impressive results of living donor liver transplantation, considerable debate persists concerning donor safety. Risks to the donor include those associated with invasive presurgical testing, surgical procedures, and postoperative care. It is important that potential donors receive accurate information on the risks of donor surgery. Although there are several studies that address complications following liver donation, most of them have focused on early postoperative complications and their medical and surgical treatments (1–8).
The purpose of our study was to evaluate the frequency of postoperative complications in liver donors and the usefulness of interventional management for treating these complications.
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MATERIALS AND METHODS
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Donors
Written informed consent was obtained from each donor, and living donor liver transplantation was approved by the ethical committee at our institution. In patients with postoperative complications in whom interventional management was performed, additional written informed consent for interventional management was obtained from each donor or from the donor’s family. Our ethical committee did not require its approval for interventional management, nor did it require its approval or patient informed consent for retrospective review of images and donor’s charts.
From January 1997 through December 2001, 386 consecutive healthy individuals were donors for liver transplantation at our institution. There were 297 male patients and 89 female patients, ranging in age from 17 to 47 years (mean, 31 years). Mean age by sex was 30.23 years ± 7.89 (± SD) and 31.67 years ± 6.54 for male and female donors, respectively; there was no statistically significant difference (P = .118). Before transplantation, each donor underwent the following liver examinations: blood chemistry analysis, check for viral hepatitis, ultrasonography (US), volumetric computed tomography (CT), conventional angiography or CT angiography, liver biopsy (if US findings indicated steatosis of the liver), and intraoperative cholangiography. All donors had normal liver function and no history of liver disease. No donor was excluded because of prohibitive anatomy. No complications occurred during preoperative evaluation.
The 386 donors underwent one of the following: right lobe (n = 217), left lobe (n = 157), left lateral segment (n = 10), or right posterior segment (n = 2) donation. For postoperative management, the usual surgical care (2,7), which included vital sign check, drainage care, wound dressing, and oral intake processing, was performed.
Postoperative Evaluation
Details of each patient’s postoperative status, including results of liver function tests, were reviewed retrospectively by one author (S.Y.L) to identify the number of days of hospitalization, the amount of time for liver function to return to normal, and the types of and management for postoperative complications. Radiologic images including conventional radiographic, US, CT, magnetic resonance (MR), diisopropyl iminodiacetic acid scintigraphic, and conventional angiographic images were also reviewed retrospectively by one author (G.Y.K) to identify the postoperative complications and their management. On radiologic images, we specifically evaluated the presence of ileus, abnormal fluid collection, biliary tree dilatation and leakage, and vascular stenosis or bleeding.
Criteria for postoperative complications included any unusual postoperative findings that induced symptoms or any abnormal findings that required medical, interventional, or surgical treatment to resolve them. Early complications were defined as those occurring within 4 weeks after donation, and delayed complications were defined as those occurring more than 4 weeks after donation.
Interventional Management and Evaluation
Interventional management consisted of percutaneous drainage, US-guided aspiration, balloon dilation after percutaneous transhepatic biliary drainage (PTBD), transcatheter arterial embolization, or stent placement in the portal vein. In all except two cases, stent placement was performed after conscious sedation with intravenously administered meperidine hydrochloride (Demerol; Keukdong Pharmaceuticals, Seoul, Korea) and/or local anesthesia with intramuscularly administered lidocaine (Jeil Pharmaceuticals, Taegu, Korea) was induced.
Percutaneous drainage and US-guided aspiration were performed with US and fluoroscopic guidance by using a 21-gauge needle (Chiba; Cook, Bloomington, Ind) and an 8.5–10.2-F drainage catheter (Cook). PTBD was performed with the 21-gauge needle in a right intercostal approach. Once the biliary system was punctured, a 5-F metal introducer set (Cook) was advanced into the biliary system over an 0.018-inch guidewire (Cook). Then, an 8.5-F drainage catheter (Cook) was inserted over a 0.035-inch guidewire (Terumo, Tokyo, Japan). In 2–5 days after PTBD, negotiation of an obstructed biliary segment and balloon dilation were performed by using a 0.035-inch guidewire and a 6–8-mm balloon catheter (Boston Scientific, Watertown, Mass). Two or three serial balloon inflations were performed for 30–60 seconds. The donor then received a 12–14-F drainage catheter interposed across the obstruction for at least 8 weeks, followed by placement of an external drainage catheter that remained for 2–4 weeks. The drainage catheter was then removed.
Transcatheter arterial embolization was performed with a 5-F cobra-shaped catheter (Cook) and a right femoral artery approach. Then the predicted bleeding arteries were selected to obtain selective arteriographic images. The bleeding arteries were predicted on the basis of the clinical information. For embolization, the bleeding artery was selected by using a coaxial microcatheter (Boston Scientific) and embolized by using microcoils (Cook).
Percutaneous transhepatic stent placement in the portal vein was performed with a 21-gauge needle with US and fluoroscopic guidance. After puncture of the intrahepatic portal vein, the needle was exchanged for a 4-F coaxial dilator and an 8-F sheath over both 0.018-inch and 0.035-inch guidewires. The 0.035-inch guidewire and a 5-F cobra-shaped catheter were then used to traverse the stenotic portal vein. Once stent placement was completed, the transhepatic tract was embolized by using 0.035-inch coils (Hilal; Cook). Anesthesia was induced in two donors, who then underwent intraoperative stent placement through the inferior mesenteric vein. Stent placement was performed with a stent that was 10–12 mm in diameter and 7 cm in length (Wallstent; Boston Scientific). The stent size in each case was chosen on the basis of the measured diameter of the proximal intrahepatic portal vein. The stent was intentionally oversized approximately 1–2 mm to minimize the risk of migration.
After interventional management, the technical success, clinical improvement, recurrence, and complications were documented retrospectively. Technical success was defined as successful achievement of the interventional procedure to correct the complications. Clinical success was defined as resolution of presenting clinical signs or symptoms. Recurrence was defined as relapse of clinical signs or symptoms. Complications were defined as those necessitating an increased level of care, surgery, prolonged hospital stay, or as permanent adverse sequelae.
Statistical Analysis
The 
2 test was used to analyze differences in frequency of postoperative complications between right and left lobe donation. Analysis was conducted with SPSS software (version 10.0.7; SPSS, Chicago, Ill), and P < .05 was considered to show a significant difference.
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RESULTS
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In all donors, liver function was aggravated immediately following donation; however, it returned to a normal range within 2 weeks in 368 (95.3%) of the donors (Table 1). In the remaining 18 donors, liver function returned to a normal range within 3 months following donation. In most donors, prolonged abnormal liver function was a sign of a postoperative complication such as a biliary stricture or portal vein stenosis and was thus excluded as a postoperative complication. All donors were discharged from the hospital 10–100 days (mean, 15 days) following donation. No donor death occurred.
After prolonged abnormal liver function was excluded as a complication, there were a total of 56 postoperative complications encountered in 52 (13.5%) donors 0–455 days (mean, 32 days) following donation (Table 2). These complications occurred in 41 (18.9%) of 217 right lobe donors and 11 (7.0%) of 157 left lobe donors. The frequency of postoperative complications was significantly higher in right lobe donors than in left lobe donors (P < .001). Among the 56 postoperative complications, 27 (48%) were managed with interventional procedures and 29 were managed with surgical (n = 2) or medical and/or conservative (n = 27) management. The 27 cases of interventional management consisted of 16 (59%) sessions of relatively minor interventional procedures, such as percutaneous drainage catheter placement (n = 10) or US-guided aspiration (n = 6), and 11 (41%) sessions of relatively major interventional procedures, such as balloon dilation after PTBD (n = 4), transcatheter arterial embolization (n = 4), or portal vein stent placement (n = 3). Surgical management consisted of one case each of surgical ligation for bleeding control and adhesiolysis.
Biliary Complications
Biliary complications were the most common setback. Most biliary complications occurred in the early postoperative period; however, four of the five biliary obstructions were detected at 7, 14, 56, and 65 weeks after donation. All biliary obstructions occurred at the transition between the common hepatic and intrahepatic ducts, and two donors had an anatomic variation (ie, trifurcation of the upper biliary confluence).
Biliary leakage, bile peritonitis, and cholangitis were treated with medical and/or conservative management. Each donor with early onset biliary obstruction and hyperbilirubinemia recovered after undergoing placement of a retrograde biliary drainage tube following balloon dilation and placement of a nasobiliary drainage tube under endoscopic guidance, respectively. Of two donors with biloma, one underwent US-guided aspiration and one underwent drainage catheter placement. Four donors with delayed onset biliary obstructions underwent between two and four sessions each of balloon dilation at the obstruction following PTBD and drainage catheter interposition across the obstruction that remained for 8–25 weeks (mean, 15 weeks) (Fig 1). These four donors recovered completely after the interventional procedures, and there were no recurrences during the 18–64-week (mean, 38 weeks) follow-up period. No procedure-related complications occurred.
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Figure 1a. Anteroposterior cholangiograms obtained in a 22-year-old man with biliary obstruction 14 weeks after right lobe donation. (a) Image obtained intraoperatively shows the very short common trunk (arrow) of the right extrahepatic duct. (b) Image obtained after percutaneous biliary drainage shows complete occlusion (arrow) of the extrahepatic duct. (c) The occluded segment was dilated by using a 6-mm balloon catheter (arrowheads). (d) Image obtained after three balloon dilations and drainage catheter interposition for 8 weeks shows a nearly normalized extrahepatic duct (arrows).
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Figure 1b. Anteroposterior cholangiograms obtained in a 22-year-old man with biliary obstruction 14 weeks after right lobe donation. (a) Image obtained intraoperatively shows the very short common trunk (arrow) of the right extrahepatic duct. (b) Image obtained after percutaneous biliary drainage shows complete occlusion (arrow) of the extrahepatic duct. (c) The occluded segment was dilated by using a 6-mm balloon catheter (arrowheads). (d) Image obtained after three balloon dilations and drainage catheter interposition for 8 weeks shows a nearly normalized extrahepatic duct (arrows).
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Figure 1c. Anteroposterior cholangiograms obtained in a 22-year-old man with biliary obstruction 14 weeks after right lobe donation. (a) Image obtained intraoperatively shows the very short common trunk (arrow) of the right extrahepatic duct. (b) Image obtained after percutaneous biliary drainage shows complete occlusion (arrow) of the extrahepatic duct. (c) The occluded segment was dilated by using a 6-mm balloon catheter (arrowheads). (d) Image obtained after three balloon dilations and drainage catheter interposition for 8 weeks shows a nearly normalized extrahepatic duct (arrows).
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Figure 1d. Anteroposterior cholangiograms obtained in a 22-year-old man with biliary obstruction 14 weeks after right lobe donation. (a) Image obtained intraoperatively shows the very short common trunk (arrow) of the right extrahepatic duct. (b) Image obtained after percutaneous biliary drainage shows complete occlusion (arrow) of the extrahepatic duct. (c) The occluded segment was dilated by using a 6-mm balloon catheter (arrowheads). (d) Image obtained after three balloon dilations and drainage catheter interposition for 8 weeks shows a nearly normalized extrahepatic duct (arrows).
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Abnormal Fluid Collection
Pleural effusion occurred in the right hemithorax (n = 8) or both hemithoraces (n = 1) following right lobe donation, and these donors underwent US-guided aspiration (n = 4) or placement of a drainage catheter (n = 5) that remained for 2–10 weeks (mean, 5 weeks). Abscesses occurred in the right subphrenic or subhepatic space following right (n = 4) or left (n = 1) lobe donation; they were treated with US-guided aspiration (n = 1) or placement of a drainage catheter (n = 4) that remained for 3–5 weeks (mean, 4 weeks) (Fig 2). All donors recovered completely without procedure-related complications.
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Figure 2a. CT images obtained in a 36-year-old man with a subhepatic abscess 2 weeks after right lobe donation. (a) Image obtained 2 weeks after right lobe donation shows a fluid collection in the subhepatic space (arrows) and another in the front of the posterior ribs (arrowheads). (b) Image obtained 7 days after placement of a drainage catheter (arrows) in the subhepatic space indicates that the abscess has disappeared. The fluid collection in the front of the posterior ribs (arrowheads) has also improved.
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Figure 2b. CT images obtained in a 36-year-old man with a subhepatic abscess 2 weeks after right lobe donation. (a) Image obtained 2 weeks after right lobe donation shows a fluid collection in the subhepatic space (arrows) and another in the front of the posterior ribs (arrowheads). (b) Image obtained 7 days after placement of a drainage catheter (arrows) in the subhepatic space indicates that the abscess has disappeared. The fluid collection in the front of the posterior ribs (arrowheads) has also improved.
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Vascular Complications
Bleeding (n = 5) occurred 1–7 days (mean, 3 days) after right lobe donation. In four of five donors, images obtained at arteriography showed an active bleeding focus from the right inferior phrenic artery (Fig 3). After embolization, these donors recovered completely without procedure-related complications. In one donor, images obtained at arteriography did not show an active bleeding focus; thus, bleeding control with interventional management failed. However, repeat surgery enabled the discovery of venous bleeding from the hepatic resection margin, and the donor recovered following revision of the hepatic resection margin.
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Figure 3a. Anteroposterior arteriograms of right inferior phrenic artery obtained in a 17-year-old boy with arterial bleeding 2 days after right lobe donation. (a, b) Images obtained through (a) a 5-F catheter and (b) a 3-F microcatheter show extravasation (arrowheads) of contrast medium. (c) Image obtained after embolization with microcoils (arrow) shows that the extravasation has disappeared.
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Figure 3b. Anteroposterior arteriograms of right inferior phrenic artery obtained in a 17-year-old boy with arterial bleeding 2 days after right lobe donation. (a, b) Images obtained through (a) a 5-F catheter and (b) a 3-F microcatheter show extravasation (arrowheads) of contrast medium. (c) Image obtained after embolization with microcoils (arrow) shows that the extravasation has disappeared.
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Figure 3c. Anteroposterior arteriograms of right inferior phrenic artery obtained in a 17-year-old boy with arterial bleeding 2 days after right lobe donation. (a, b) Images obtained through (a) a 5-F catheter and (b) a 3-F microcatheter show extravasation (arrowheads) of contrast medium. (c) Image obtained after embolization with microcoils (arrow) shows that the extravasation has disappeared.
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Portal vein stenosis or kink (n = 3) was identified during donation or at 4 or 9 days after right lobe donation in the three patients, respectively. These donors had a portal vein variation (ie, the right posterior segmental portal vein took off directly from the main portal vein). In these donors, the right anterior and posterior portal veins were transected en bloc from the main portal vein. In the first donor, a portal vein kink between the main and left portal veins was not completely relieved after right lobectomy in the surgical field. Thus, interventional radiologists performed stent placement intraoperatively. One of the other two donors underwent repeat surgery; however, the portal vein kink was still not completely relieved, and, subsequently, interventional radiologists performed stent placement intraoperatively. In the last donor, follow-up MR images demonstrated a stenosis at the same location as in the two other donors; therefore, stent placement was performed with a percutaneous approach (Fig 4). After stent placement, the donors recovered completely without any procedure-related complications, and portal flow was maintained during the 83–158-week (mean, 118 weeks) follow-up period, as observed on CT and Doppler US images.
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Figure 4a. Images obtained in a 31-year-old woman with portal vein stenosis 9 days after right lobe donation. (a) Anteroposterior image obtained at preoperative indirect portal venography shows a portal variation: The right posterior segmental portal vein (arrow) branches directly from the main portal vein (arrowhead). (b) Coronal image obtained at follow-up MR angiography shows tight stenosis (arrow) between the main and left portal veins. (c, d) Anteroposterior images obtained at direct portal venography with a percutaneous transhepatic approach show stenosis (arrow) between main and left portal veins. After stent (arrowheads) placement (d), the stenosis improved.
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Figure 4b. Images obtained in a 31-year-old woman with portal vein stenosis 9 days after right lobe donation. (a) Anteroposterior image obtained at preoperative indirect portal venography shows a portal variation: The right posterior segmental portal vein (arrow) branches directly from the main portal vein (arrowhead). (b) Coronal image obtained at follow-up MR angiography shows tight stenosis (arrow) between the main and left portal veins. (c, d) Anteroposterior images obtained at direct portal venography with a percutaneous transhepatic approach show stenosis (arrow) between main and left portal veins. After stent (arrowheads) placement (d), the stenosis improved.
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Figure 4c. Images obtained in a 31-year-old woman with portal vein stenosis 9 days after right lobe donation. (a) Anteroposterior image obtained at preoperative indirect portal venography shows a portal variation: The right posterior segmental portal vein (arrow) branches directly from the main portal vein (arrowhead). (b) Coronal image obtained at follow-up MR angiography shows tight stenosis (arrow) between the main and left portal veins. (c, d) Anteroposterior images obtained at direct portal venography with a percutaneous transhepatic approach show stenosis (arrow) between main and left portal veins. After stent (arrowheads) placement (d), the stenosis improved.
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Figure 4d. Images obtained in a 31-year-old woman with portal vein stenosis 9 days after right lobe donation. (a) Anteroposterior image obtained at preoperative indirect portal venography shows a portal variation: The right posterior segmental portal vein (arrow) branches directly from the main portal vein (arrowhead). (b) Coronal image obtained at follow-up MR angiography shows tight stenosis (arrow) between the main and left portal veins. (c, d) Anteroposterior images obtained at direct portal venography with a percutaneous transhepatic approach show stenosis (arrow) between main and left portal veins. After stent (arrowheads) placement (d), the stenosis improved.
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Other Complications
Other complications following donation are listed in Table 2. All but two complications were resolved with medical and/or conservative management. One donor with mechanical ileus underwent surgical adhesiolysis, and a donor with acute renal failure after right lobe donation has been treated with hemodialysis.
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DISCUSSION
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In healthy liver donors, the major concern is donor morbidity and mortality. According to previous data regarding liver donors, reported complication rates range from 0% to 67% (1–13). Our results showed that the overall complication rate in liver donors was 13.5%, which was relatively lower than that in previous reports. This wide range of complication rates is undoubtedly caused by the difference in the extent of liver donation segments and the lack of consensus on the definition of a complication (13). Some investigators may have included every minor postoperative complication (2–5), whereas others reported only severe or life-threatening complications (9,11,14,15). Beavers et al (13) documented that reported morbidity associated with right lobe donation for living donor liver transplantation varied widely (0%–67%), and they stressed the necessity for standardized definitions of morbidity and better methods for observing and measuring outcomes after liver donation in order to understand and potentially improve morbidity. Our data showed that the frequency of postoperative complications was significantly higher in right lobe donors than in left lobe donors. Fujita et al (3) and Miller et al (12) also reported a higher incidence of postoperative complications following right lobe donation than either left lobe or left lateral segment donation. In addition, as we identified postoperative complications only by review of patient charts and radiologic images, numerous minor complications may have been overlooked.
According to the observations during the interval between liver donation and the occurrence of complications, it was obvious that most complications occurred in the early postoperative period; biliary obstructions, however, frequently occurred in the delayed postoperative period. Thus, clinicians should be mindful of the possibility of biliary obstructions even after the donor has been discharged without complications.
Most complications occurring after liver donation do not require interventional or surgical treatment (1–10). Permanent sequelae or death is also very rare. To our knowledge, only one case of donor mortality due to pulmonary embolism has been reported in the literature (14). In our study, no donor death occurred. However, a permanent sequela occurred in one donor; this was acute renal failure, which occurred 3 days after uneventful right lobe donation. In this donor, postoperative renal function was normal but deteriorated abruptly on day 3 following right lobe donation. Although the cause of the renal failure was uncertain, it was suspected to be drug induced.
Although there have been several reports concerning biliary obstructions treated with surgical procedures (7,9,15), most biliary complications have been resolved with conservative or minor invasive treatments such as percutaneous drainage (2–5,8,12). Our results also agreed with those in these reports. However, four donors with biliary obstructions had to undergo major invasive procedures (ie, PTBD and balloon dilation). The use of these procedures has been reported in liver transplant recipients (16,17) but not in donors. In our study, the four donors recovered completely following the interventional management; however, they suffered from great inconveniences for a long time during the period of interventional management. Although there was no recurrence in any donors, our follow-up period (mean, 38 weeks) was quite short to determine the long-term efficacy of interventional management. In addition, most donors in our study were young adults. Thus, further long-term clinical and radiologic follow-up is needed to determine the long-term efficacy of PTBD and balloon dilation because we cannot exclude the possibility of recurrent biliary obstruction in the future.
Reported vascular complications in liver donors are rare. In the literature, we found one case each of hepatic artery and portal vein thromboses, both of which were managed with repeat surgery (2,5). It is interesting that in our study, the right inferior phrenic artery bled in four donors following right lobe donation. This may be related to injury to the diaphragm or perihepatic tissues during retraction of the diaphragm or dissection of the right lobe from the surrounding tissue. Although there are several potential bleeding arteries, clinicians should examine the right inferior phrenic artery if bleeding occurs following right lobe donation. In addition, clinicians should consider the possibility of venous bleeding if images obtained at arteriography fail to demonstrate a bleeding focus. In one donor in our study, images obtained at arteriography did not demonstrate a bleeding focus, but findings at repeat surgery confirmed venous oozing.
It is interesting to note that portal vein stenosis or kink occurred following right lobe donation in three donors with a portal vein variation. Surgical management in two of these donors was insufficient to improve the portal flow. Therefore, we performed stent placement intraoperatively or with a percutaneous approach, and the donors conditions improved without procedure-related complications. Although our follow-up period was not long enough to evaluate long-term patency of portal vein stent placement, portal flow was maintained for a mean of 118 weeks without recurrence. Thus, we assume that stent placement is an effective and safe alternative for treating portal vein stenosis or kink following liver donation.
Marcos et al (18) indicated the importance of presurgical evaluation of anatomic variations in potential donors. Although we did not fully evaluate the correlation between anatomic variations and postoperative complications, our two donors with biliary obstructions and three donors with portal vein stenosis or kink did have anatomic variations. Thus, clinicians should entertain the possibility of biliary or portal vein complications in donors with anatomic variations.
To treat postoperative complications, we applied interventional management more frequently than in previously reported studies. However, only 11 (41%) of 27 complications required major interventional procedures, such as transcatheter arterial embolization, balloon dilation, or stent placement. The remaining 16 (59%) complications were managed with relatively minor interventional procedures. After interventional management, these 27 complications were completely resolved without procedure-related complications.
In summary, our data reveal a spectrum of postoperative complications in liver donors. Most of these complications occurred in the early postoperative period; biliary obstructions, however, frequently occurred in the delayed postoperative period. Although complications were not uncommon in our donors, most complications were minor and had no long-term sequelae after medical or interventional management. Interventional management seems to be useful for treatment of postoperative complications following liver donation in selected donors.
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ACKNOWLEDGMENTS
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We thank Bonnie Hami, MA, and the Department of Radiology, University Hospitals Health System of Cleveland, Ohio, for editorial assistance in preparing the manuscript.
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FOOTNOTES
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Abbreviation: PTBD = percutaneous transhepatic biliary drainage
Author contributions: Guarantors of integrity of entire study, G.Y.K., K.B.S.; study concepts, G.Y.K., H.Y.S.; study design, S.Y.L., G.Y.K.; literature research, S.Y.L., G.Y.K., D.I.G.; clinical studies, H.K.Y., K.B.S., G.Y.K., S.G.L., D.I.G.; data acquisition, S.Y.L., G.Y.K.; data analysis/interpretation, G.Y.K., K.B.S.; statistical analysis, G.Y.K.; manuscript preparation, S.Y.L., G.Y.K.; manuscript definition of intellectual content, G.Y.K., K.B.S.; manuscript editing, K.B.S., H.Y.S.; manuscript revision/review, H.K.Y., K.B.S.; manuscript final version approval, G.Y.K.
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