Live donor hepatectomy for liver transplantation in Egypt: Lessons learned
Purpose: To retrospectively review anesthesia and intensive care management of 145 consented volunteers subjected to right lobe or left hepatectomy between 2003 and 2011. Methods: After local ethics committee approval, anesthetic and intensive care charts, blood transfusion requirements, laboratory...
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Wolters Kluwer Medknow Publications
2012-01-01
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doaj-939763e8ff224ddb800c2d145215c4fe2020-11-25T00:21:12ZengWolters Kluwer Medknow PublicationsSaudi Journal of Anaesthesia1658-354X2012-01-016323424110.4103/1658-354X.101214Live donor hepatectomy for liver transplantation in Egypt: Lessons learnedEmad KamelMohamed AbdullahAshraf HassaninNirmeen FayedFatma AhmedHossam SolimanOsama HegaziYasmine Abd El SalamMagdy KhalilKhaled YassenIbrahim MarwanKoichi TanakaKhaled AboEllaTarek IbrahimPurpose: To retrospectively review anesthesia and intensive care management of 145 consented volunteers subjected to right lobe or left hepatectomy between 2003 and 2011. Methods: After local ethics committee approval, anesthetic and intensive care charts, blood transfusion requirements, laboratory data, complications and outcome of donors were analyzed. Results: One hundred and forty-three volunteers successfully tolerated the surgery with no blood transfusion requirements, but with a morbidity rate of (50.1%). The most frequent complication was infection (21.1%) (intraabdominal collections), followed by biliary leak (18.2%). Two donors had major complications: one had portal vein thrombosis (PVT) treated with vascular stent. This patient recovered fully. The other donor had serious intraoperative bleeding and developed postoperative PVT and liver and renal failure. He died after 12 days despite intensive treatment. He was later reported among a series of fatalities from other centers worldwide. Epidural analgesia was delivered safely (n=90) with no epidural hematoma despite significantly elevated prothrombin time (PT) and international normalization ratio (INR) postoperatively, reaching the maximum on Day 1 (16.9±2.5 s and 1.4±0.2, P<0.05 when compared with baseline). Hypophosphatemia and hypomagnesemia were frequently encountered. Total Mg and phosphorus blood levels declined significantly to 1.05±0.18 mg/dL on Day 1 and 2.3±0.83 mg/dL on Day 3 postoperatively. Conclusions: Coagulation and electrolytes need to be monitored perioperatively and replaced adequately. PT and INR monitoring postoperatively is still necessary for best timing of epidural catheter removal. Live donor hepatectomy could be performed without blood transfusion. Bile leak and associated infection of abdominal collections requires further effort to better identify biliary leaks and modify the surgical closure of the bile ducts. Donor hepatectomy is definitely not a complication-free procedure; reported complication risks should be available to the volunteers during consenting.http://www.saudija.org/article.asp?issn=1658-354X;year=2012;volume=6;issue=3;spage=234;epage=241;aulast=KamelDonor hepatectomyEgyptliving donor liver transplantationperioperative experience |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Emad Kamel Mohamed Abdullah Ashraf Hassanin Nirmeen Fayed Fatma Ahmed Hossam Soliman Osama Hegazi Yasmine Abd El Salam Magdy Khalil Khaled Yassen Ibrahim Marwan Koichi Tanaka Khaled AboElla Tarek Ibrahim |
spellingShingle |
Emad Kamel Mohamed Abdullah Ashraf Hassanin Nirmeen Fayed Fatma Ahmed Hossam Soliman Osama Hegazi Yasmine Abd El Salam Magdy Khalil Khaled Yassen Ibrahim Marwan Koichi Tanaka Khaled AboElla Tarek Ibrahim Live donor hepatectomy for liver transplantation in Egypt: Lessons learned Saudi Journal of Anaesthesia Donor hepatectomy Egypt living donor liver transplantation perioperative experience |
author_facet |
Emad Kamel Mohamed Abdullah Ashraf Hassanin Nirmeen Fayed Fatma Ahmed Hossam Soliman Osama Hegazi Yasmine Abd El Salam Magdy Khalil Khaled Yassen Ibrahim Marwan Koichi Tanaka Khaled AboElla Tarek Ibrahim |
author_sort |
Emad Kamel |
title |
Live donor hepatectomy for liver transplantation in Egypt: Lessons learned |
title_short |
Live donor hepatectomy for liver transplantation in Egypt: Lessons learned |
title_full |
Live donor hepatectomy for liver transplantation in Egypt: Lessons learned |
title_fullStr |
Live donor hepatectomy for liver transplantation in Egypt: Lessons learned |
title_full_unstemmed |
Live donor hepatectomy for liver transplantation in Egypt: Lessons learned |
title_sort |
live donor hepatectomy for liver transplantation in egypt: lessons learned |
publisher |
Wolters Kluwer Medknow Publications |
series |
Saudi Journal of Anaesthesia |
issn |
1658-354X |
publishDate |
2012-01-01 |
description |
Purpose: To retrospectively review anesthesia and intensive care management of 145 consented volunteers subjected to right lobe or left hepatectomy between 2003 and 2011. Methods: After local ethics committee approval, anesthetic and intensive care charts, blood transfusion requirements, laboratory data, complications and outcome of donors were analyzed. Results: One hundred and forty-three volunteers successfully tolerated the surgery with no blood transfusion requirements, but with a morbidity rate of (50.1%). The most frequent complication was infection (21.1%) (intraabdominal collections), followed by biliary leak (18.2%). Two donors had major complications: one had portal vein thrombosis (PVT) treated with vascular stent. This patient recovered fully. The other donor had serious intraoperative bleeding and developed postoperative PVT and liver and renal failure. He died after 12 days despite intensive treatment. He was later reported among a series of fatalities from other centers worldwide. Epidural analgesia was delivered safely (n=90) with no epidural hematoma despite significantly elevated prothrombin time (PT) and international normalization ratio (INR) postoperatively, reaching the maximum on Day 1 (16.9±2.5 s and 1.4±0.2, P<0.05 when compared with baseline). Hypophosphatemia and hypomagnesemia were frequently encountered. Total Mg and phosphorus blood levels declined significantly to 1.05±0.18 mg/dL on Day 1 and 2.3±0.83 mg/dL on Day 3 postoperatively. Conclusions: Coagulation and electrolytes need to be monitored perioperatively and replaced adequately. PT and INR monitoring postoperatively is still necessary for best timing of epidural catheter removal. Live donor hepatectomy could be performed without blood transfusion. Bile leak and associated infection of abdominal collections requires further effort to better identify biliary leaks and modify the surgical closure of the bile ducts. Donor hepatectomy is definitely not a complication-free procedure; reported complication risks should be available to the volunteers during consenting. |
topic |
Donor hepatectomy Egypt living donor liver transplantation perioperative experience |
url |
http://www.saudija.org/article.asp?issn=1658-354X;year=2012;volume=6;issue=3;spage=234;epage=241;aulast=Kamel |
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