Status:
Ready to upload
Record number:
1499
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
The survey revealed 23 donor deaths among 11,553 donor hepatectomy procedures (0.2%), with exclusion criteria (2 deaths from lung cancer at 22 months and 3.4 years, 1 from asthma at 5 years and 1from myocardial infarction at 6 years) the mortality incidence was 0.16%. The overall reported donor morbidity rate was 23.9% +/-13.9%, with most events (85.8%) occurring within the first 30 postoperative days.
Time to detection:
0 days - 22 months
Alerting signals, symptoms, evidence of occurrence:
The survey revealed 23 donor deaths among 11,553 donor hepatectomy procedures (0.2%); 18 were reported directly by centers, and 5 additional reports were received from the European Liver Transplant Registry. Single deaths were reported by 8 centers, 2 centers reported 2 deaths each, and 2 centers reported 3 deaths each. The majority of the deaths (15/23) occurred within 60 days of donation and ranged from an intraoperative death to suicide at 60 days. These deaths spanned the entire spectrum of donor follow-up and included 4 deaths unlikely to be related to the donation surgery.
Demonstration of imputability or root cause:
Surveys were sent to all liver transplant programs. The Clavien system was used to standardize morbidity data. All data was reviewed by the authors.
Imputability grade:
2 Probable
Groups audience:
Keywords:
Suggest new keywords:
incisional hernias, bile leaks, near miss events, hemorrhage, sepsis, morbidity, lobectomy
Reference attachment:
Suggest references:
Cheah, YL, Simpson, MA, Pomposelli, JJ, Pomfret, EA. (2013). Incidence of death and potentially life-threatening near-miss events in living donor hepatic lobectomy: a world-wide survey. Liver Transpl. 19(5):499-506. doi: 10.1002/lt.23575.
Expert comments for publication:
Aborted hepatectomies and potentially life-threatening near-miss events (during which a donor’s life may be in danger but after which there are no long-term sequelae) are rarely reported. A worldwide survey of programs performing living donor liver transplant to determine the incidence of these events. The most common complications were bile leaks, wound infections, incisional hernias, and unplanned surgical re-exploration. Survey results indicated that 126 near-miss events occurred in 125 patients, so the incidence was 1.1%. Hemorrhaging requiring surgical intervention was cited most frequently, and this was followed by thrombotic events, biliary reconstruction procedures, life-threatening sepsis, and iatrogenic injury to the bowel or vasculature. Six instances of transient hepatic insufficiency were reported. The living liver donor community must develop a universally accessible reporting system that will allow a critical analysis of all events so that donor safety can be maximized.