Living donors recuperate well

NEW YORK (Reuters Health) -- A sample of adults who donated a portion of their livers to a child who needed a liver transplant -- in most cases, their own child -- said they eventually recuperated well from the procedure, US researchers report.

Furthermore, the majority of donors said they endorsed so-called "living donation," regardless of how well the receiving child fared after the procedure.

"Even when you look at adults whose babies did not do well, they still don't regret it," said study author Dr John Renz of the University of California.

When an adult donates a portion of his or her liver to a child, doctors extract up to one-quarter of the adult's liver and transplant it into a child. The procedure differs markedly from living donations from one adult to another, which require that the donor offer up to 65% of their own livers. The donor and recipient need not be genetic matches, but both must share a blood type.

Incredibly, adult donors typically recover up to 95% of their original liver volume within 7 days, on account of the organ's powerful ability to regenerate itself. Consequently, most of the recuperation period stems from elements of the operation itself, such as the size of the incision and the need to divide abdominal muscles to reach the liver.

Children need new livers for a variety of reasons, such as end-stage liver disease as a result of chronic illness, or sudden liver failure, which can develop within a matter of days.

While living-donor liver transplants have cut children's waiting time for organs and reduced their risk of death while waiting, 10 to 15% of donors experience complications from the procedure, ranging from bleeding, developing a potentially fatal blood clot in the lungs, hernia, or bowel obstruction after the procedure.

Furthermore, Renz and his team report that 89% of donors said living-donor liver transplantation should be used in more than just "emergency" situations, when the child needs a liver immediately.

He suspected these results applied strictly to adults who donate livers to children. Transplanting from one adult to another is a more extensive procedure, and as such, the recovery period can take longer. In some cases, liver donors have died after the operation.

Furthermore, when an adult donates a portion of his or her liver to another adult, the relationship between the two is likely different than when a parent donates to a child, Renz said.

Based on studies of living-donor kidney transplantation, donors can feel differently about the procedure depending on their relationship with the recipient, the researcher added. "There's always, always higher donor satisfaction among first degree relatives than among any other group," Renz said.

SOURCE: Annals of Surgery 2002;236:120-126.

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