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Major Liver Donor Surgery Problems

Clip Number: 20 of 25
Presentation: Liver Donation Evaluation
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Reviewed By: Arthur Schoenstadt, MD
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Many types of problems can happen during this surgery. We'll now talk about the most common or potentially serious problems that can happen either during or after liver donation surgery.
For the liver itself, these problems include:
• Bile duct problems, such as bile leakage, which happens in up to 1 out of 10 liver donation surgeries. Leaking bile usually stops by itself, but sometimes additional medical attention or even surgery is needed to control a bile leak.
• The bile duct can also become narrowed after this surgery. This is called a "stricture," and happens as scar tissue builds up around the bile duct. Because scar tissue can form over a long period of time, this problem can occur quite some time after the operation. Strictures happen in less than 1 in 100 cases, but if you do develop a stricture, you may need to have a tube placed in the duct to keep it open, or another surgery to correct the problem.
Other problems that are possible include:
• Clotting or damage to the blood vessels attached to the liver. This may require additional x-ray studies or even another operation.
• Serious bleeding that requires a blood transfusion or another surgery.
• And liver failure. This can happen if your remaining liver doesn't grow enough after the surgery and is unable to perform its important functions. If this happens, you may need a liver transplant yourself. So far, this has happened once in the United States, for a rate of about 1 in 1000 cases.
This surgery also has some risks that are related to having any major type of operation. The risks that are thought to happen in more than 1 out of 100 surgeries include:
• Pressure damage to the nerves or skin. This can happen as a result of lying on the operating table for several hours, and is the most frequently mentioned problem. Some people experience temporary arm numbness or pressure sores. This happens in about 3 to 5 out of 100 cases.
• Interrupted surgery, which is when the surgery is stopped if your doctor feels you are at risk or that your liver is not right for transplantation. This also includes when something happens during the recipient's surgery that makes it necessary to stop the transplant. In the US, this happens in about 1 out of 20 surgeries.
• Infection at the surgical site, which happens in about 1 of 20 cases.
• Hernia at the surgical incision -- less than 1 in 20 cases.
• Fluid buildup in the chest that requires a drainage tube -- 1 out of 20.
• Bowel obstruction, which happens in about 1 out of 33 cases over the lifetime of those who have had a major abdominal surgery.
• Infection in the abdomen - about 1 out of 100.
• Spleen damage, which has only been reported when the left lobe is donated, and in less than 1 out of every 100 liver donation surgeries.
• And blood clots, including deep vein thrombosis and pulmonary embolism, which is when a clot travels to the lungs and causes problems there.
It's important to know that depression is common after stressful events, like a major surgery. While the exact frequency of depression in liver donors isn't known yet, about 1 to 2 of every 10 healthy kidney donors experience depression after their surgery.
Again, there IS a very small risk of death during this surgery. Currently, about 1 out of every 500 liver donors will die as a direct result of this surgery. In the more than 1000 living-donor procedures done in the US, there have been two deaths.
If any of these problems develop, the treatment will depend on where it happens, how serious it is, and other factors including your overall health. You may need to stay in the hospital longer than planned, and for some complications you might even need to have a blood transfusion or another surgery. Other problems may cause a permanent disability or loss of life. Talk with your doctor if you have any questions or concerns about the possible risks of this surgery.
 

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