http://whtc.com/news/articles/2011/nov/04/liver-donors-have-complaints-years-later-study/Liver donors have complaints years later: study
By Andrew M. Seaman
A new study on the long-term effects of giving away a portion of one's liver for transplant shows donors can experience physical and psychological complications years after the operation.
Almost half of the 83 liver donors surveyed had complaints ranging from pain and digestive problems to depression three or more years after surgery. But nearly all said they'd donate again, according to the study published in the Annals of Surgery.
"There is a risk for some long-term complaints, which may be potentially controllable by workup modifications, improvements in surgical techniques and a thorough follow-up of donors at the transplant centers," Dr. Georgios Sotiropoulos, lead author and professor of surgery and transplantation at University Hospital Essen in Germany, told Reuters Health in an email.
Prospective donors should be thoroughly informed of possible long-term effects of donation, Sotiropoulos' team wrote in their report, and many of the donors surveyed suggested a central registry of living donors to track how they fared over time.
In a living donor liver transplant, a team of surgeons removes a lobe of the donor's liver to implant in the recipient. The remaining portion of the donor's liver regrows to full size within two months.
Transplant surgeons say they would rather not have to put a healthy person at risk by taking a piece of their liver for someone else, but there aren't enough organs available to provide livers for everyone who needs them.
At the end of October, according to the U.S. Organ Procurement and Transplantation Network, more than 16,000 patients were on the waiting list for a liver transplant -- and nearly 900 patients have died so far this year because no liver became available for them.
The severe shortage and the liver's unique ability to regenerate itself are why doctors turn to living donors.
Organs from living donors also have some advantages over the alternative, a liver from a cadaver, because a living donor is typically healthier and the donation can occur at the best time for the recipient.
The average age of donors in the German study was 36, and their average time since donating was six years.
In the study, 31 percent of donors complained about having diarrhea or an intolerance to fatty foods. About 10 percent complained of gastroesophageal reflux and a small number of donors had discomfort at the incision site or in the ribs. Three donors reported bouts of severe depression -- two of them requiring hospitalization -- and one patient had worsening of preexisting psoriasis.
Of the 83 donors surveyed, 39 reported no lingering symptoms or problems.
Three young and otherwise healthy men, however, said they had been turned down for life insurance because there's so little data available on the long-term effects of living liver donation.
Dr. Jean Emond, vice chair of the Department of Surgery and director of the transplant center at New York Presbyterian/Columbia Hospital in New York, said, though the study did not have a control group, its findings are consistent with past research.
"I think the conclusions are cautious and reasonable," said Emond. "We need to keep a close eye on these people."
Emond told Reuters Health that his center aims to bring donors back for checkups once a year.
"A lot of them don't want to come back because they feel good, because it's too much trouble or their (recipient) died and they don't want to be reminded of the bad memories," said Emond. "The other thing is if they live far away it could be hard to do."
He added that there needs to be psychological support before and after the procedure.
"In our center we have a psychiatrist ... to try and understand the makeup that may be exacerbated under the stress of donation," said Emond.
About 4,500 liver donations have been made in the U.S. by living donors since the first surgery in 1989, according to the national transplant database.
The first liver donations from living donors were made to children, who require a smaller piece of the liver than adults.
Emond, who assisted with the first live-donor liver surgery, said the procedure slowly grew in the U.S. until 2001. The following year an infection killed a donor at Mount Sinai Medical Center in New York. According to Emond, the high-profile case led to more stringent regulations for the procedure.
Last year two donors died after the operation, one in Massachusetts and another in Colorado.
"This year was a tough year," said Emond. "Unlike the first two deaths that happened in the U.S., these two deaths happened in centers that have superb safety programs in place. It really shook everybody in the community that's doing it." But Emond added that doctors cannot expect everyone to survive the risky surgery.
According to Emond, the risk of death after donating a large portion of the liver is about one in 1,000.
"The ethical standard has to be that you do it because it's the right thing to do for the patient with full and informed consent," said Emond.
SOURCE: Annals of Surgery, November 2011.
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