“No go” donor hepatectomy in living-donor liver transplantation

Viniyendra Pamecha, Kishore G. S. Bharathy, Shyam S. Mahansaria, Piyush K. Sinha, Archana Rastogi, Shridhar V. Sasturkar

Selection of appropriate donors after rigorous evaluation is of paramount importance in living-donor liver transplantation. Despite this, donor surgery may not proceed due to unforeseen reasons. The aim of this paper is to study reasons for "no go" donor hepatectomy in living liver donors. Donor operations stopped after surgical start, directly due to donor safety-related reasons, qualified for inclusion as "no go" donor hepatectomy. Living-donor evaluation was performed as per standard protocol. Data for consecutive living liver donors operated between April 2012 and November 2016 were analyzed to evaluate reasons for "no go" donor hepatectomy in a liver transplantation unit at a tertiary care teaching hospital. In 307 donors, the operation was aborted in 7 (2.3 %). One patient had unexpected biliary pathology with fibrosis found intraoperatively. Operations in five donors were abandoned in view of liver parenchymal abnormalities (fibrosis/steatohepatitis). One donor had hemodynamically significant bradycardia after handling the round ligament. All these donors recovered uneventfully and remained well on follow-up. "No go" donor hepatectomy remains a real possibility despite rigorous assessment. Although thresholds for on-table rejection of the donor after complete evaluation vary, "no go" hepatectomy is a calculated risk-avoidance approach.