Increased risk of bile duct complications for some living donor liver transplantation recipients

With a critical shortage of donated organs, living donor liver transplantation (LDLT) has become widely accepted in the US as a potential alternative to deceased organ transplant. However, LDLT is a technically challenging procedure that requires sophisticated training, which has limited the growth of LDLT programs. To add to the knowledge in this area and help guide surgical decisions, researchers compared outcomes and complications after surgery for different LDLT approaches.

The long-term psychosocial impact of liver donation

In order for potential liver donors to be fully informed about the risks of donation, they need to have information about the long-term impacts of donation. Studies have examined liver donors’ long-term medical outcomes, but there have been no analogous studies on long-term psychosocial outcomes. To address this gap, researchers examined data from the Adult to Adult Living Donor Liver Transplantation Cohort Study-2 (A2ALL-2) to learn about clinically significant mental health problems and self-reported physical health problems in the long-term years after liver donation.

Modifying liver blood flow in liver transplant recipients

The portal vein carries 75 percent of the blood flow to the liver, with the remainder flowing through the hepatic artery. If blood flow through the portal vein is too high, the hepatic artery becomes constricted and blood flow through it decreases. This leads to damage to the liver and surrounding tissues. In liver donation recipients, increased portal blood flow can lead to graft failure; failure of small grafts in particular has been attributed to excess portal blood flow.

Psychological outcomes of living liver donors in A2ALL

Living liver donation can be psychologically as well as physically demanding for donors. While single-center and cross-sectional studies have suggested that liver donation has a modest impact on donor psychological well-being, few studies have assessed these outcomes prospectively among a large cohort. Using data from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL-2), one of the largest, prospective, multi-center studies of psychological outcomes in living liver donors, researchers evaluated trends in psychological outcomes over time and potential predictors of these outcomes.

More efforts needed to reduce financial burdens for living liver donors

Living liver donation is increasingly viewed as a favorable alternative to deceased donor transplantation, leading to efforts to maximize donor well-being. However, little data exists on the impact of donation on liver donors’ lives. To address this gap, researchers used data from the Adult-to-Adult Living Donor Liver Transplant Cohort Study-2 (A2ALL-2) to examine outcomes for living liver donors in the first two years after donation. 271 donors from nine North American transplant centers responded to at least one pre- or post-donation survey assessing social and financial measures.

New investigation emphasizes negative impact of acute rejection after liver transplantation

Even though acute rejection after solid organ transplantation is often treatable, it may place recipients at increased risk of progressive graft failure and death. Liver transplantation has been considered the exception to this rule; however, this exception is based on nearly 20-year-old data.

Preoperative interventions may mitigate postoperative pain in living liver donors

Little is known about how well postoperative pain is managed in living liver donors, despite the fact that pain severity is the strongest predictor of long-term disability due to chronic pain. Using data from the Adult to Adult Living Donor Liver Transplantation Cohort Study (A2ALL), researchers identified donor characteristics that influenced postoperative pain and evaluated postoperative pain management.

New paper from A2ALL investigates risk factors for early allograft dysfunction

After living donor liver transplantation, a recipient may experience complications with the transplanted organ soon after surgery. Early Allograft Dysfunction (EAD) may occur when the liver is too small to meet recipient needs, although factors other than size can contribute to EAD. Recent acceptable results with smaller left lobe grafts suggest that the effects of graft size could be mitigated with careful patient selection and technical innovation, such as inflow modification. This has led to renewed interest in smaller grafts to reduce risk to donors during surgery without compromising recipient outcomes.

Psychosocial Outcomes 3 to 10 Years After Donation in the Adult to Adult Living Donor Liver Transplantation Cohort Study (A2ALL)

Previous studies of living liver donors’ psychological and social outcomes have focused on short-term outcomes and rely largely on measures not specific to donation. In a recent paper published in a special issue on living donation in Transplantation, researchers examined long-term psychosocial outcomes of living donors, focusing on a more specific assessment of donors’ potential problems.

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