Saudi Journal of Anaesthesia

ORIGINAL ARTICLE
Year
: 2012  |  Volume : 6  |  Issue : 3  |  Page : 234--241

Live donor hepatectomy for liver transplantation in Egypt: Lessons learned


Emad Kamel1, Mohamed Abdullah1, Ashraf Hassanin1, Nirmeen Fayed1, Fatma Ahmed1, Hossam Soliman2, Osama Hegazi2, Yasmine Abd El Salam1, Magdy Khalil1, Khaled Yassen1, Ibrahim Marwan2, Koichi Tanaka2, Khaled AboElla2, Tarek Ibrahim2 
1 Department of Anaesthesia, National Liver Institute, Menoufiya University, Shebeen El Kom, Menoufiya, Egypt
2 Department of Hepato-Biliary Surgery, National Liver Institute, Menoufiya University, Shebeen El Kom, Menoufiya, Egypt

Correspondence Address:
Khaled Yassen
11 A Khalil El Khaiat, Moustafa Kamael Alexandria
Egypt

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.


How to cite this article:
Kamel E, Abdullah M, Hassanin A, Fayed N, Ahmed F, Soliman H, Hegazi O, El Salam YA, Khalil M, Yassen K, Marwan I, Tanaka K, AboElla K, Ibrahim T. Live donor hepatectomy for liver transplantation in Egypt: Lessons learned.Saudi J Anaesth 2012;6:234-241


How to cite this URL:
Kamel E, Abdullah M, Hassanin A, Fayed N, Ahmed F, Soliman H, Hegazi O, El Salam YA, Khalil M, Yassen K, Marwan I, Tanaka K, AboElla K, Ibrahim T. Live donor hepatectomy for liver transplantation in Egypt: Lessons learned. Saudi J Anaesth [serial online] 2012 [cited 2023 Jan 26 ];6:234-241
Available from: https://www.saudija.org/article.asp?issn=1658-354X;year=2012;volume=6;issue=3;spage=234;epage=241;aulast=Kamel;type=0