Living donor liver transplantation in South Africa: the donor experience

  • J F Botha Wits Donald Gordon Medical Centre
  • B Ströbele Wits Donald Gordon Medical Centre
  • J Loveland Wits Donald Gordon Medical Centre
  • S Rambarran Wits Donald Gordon Medical Centre
  • R Britz Wits Donald Gordon Medical Centre
  • H Etheredge Wits Donald Gordon Medical Centre
  • H Maher Wits Donald Gordon Medical Centre
  • S Bolon University of the Witwatersrand
  • M Eagar Wits Donald Gordon Medical Centre
  • A Beeton University of the Witwatersrand
  • L Brannigan University of the Witwatersrand
  • R Mononyane Wits Donald Gordon Medical Centre
  • S Bannan Wits Donald Gordon Medical Centre
  • M Morford Wits Donald Gordon Medical Centre
  • O Smith University of the Witwatersrand
  • J Fabian Wits Donald Gordon Medical Centre
Keywords: living donor, liver transplantation, South Africa, experience

Abstract

Background: Living donor liver transplantation (LDLT) plays a crucial role in liver transplant programmes, particularly in regions with a scarcity of deceased donor organs and especially for paediatric recipients. LDLT is a complex and demanding procedure which places a healthy living donor in harm’s way. Donor safety is therefore the overriding concern. This study aimed to report our standardised approach to the evaluation, technical aspects and outcomes of LDLT donor hepatectomy at Wits Donald Gordon Medical Centre.

Methods: The study population consisted of all patients undergoing LDLT donor hepatectomy since the inception of the programme in March 2013 until 2018. Sixty five living donor hepatectomies were performed. Primary outcome measures included donor demographics, operative time, peak bilirubin, aspartate and alanine transaminase levels postoperatively, length of hospital stay and postoperative complications using the Clavien-Dindo classification.

Results: The majority of the donors were female, most were parents with mothers being the donor almost 85% of the time. The median operative time was 374 minutes with a downward trend over time as experience was gained. The median length of hospital stay was 7 days. There was no mortality and the complication rate was 30% with the majority being minor (Grade 1).

Conclusion: Living donor liver transplant from adult-to-child has been successfully initiated in South Africa. Living donor hepatectomy can be safely performed with acceptable outcomes for the donor. Wait-list mortality however remains unacceptably high. Expansion of LDLT as well as real change in deceased donor policy is required to address this issue.

Author Biographies

J F Botha, Wits Donald Gordon Medical Centre

Wits Donald Gordon Medical Centre, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa

B Ströbele, Wits Donald Gordon Medical Centre

Wits Donald Gordon Medical Centre, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa

J Loveland, Wits Donald Gordon Medical Centre

Wits Donald Gordon Medical Centre, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa

S Rambarran, Wits Donald Gordon Medical Centre

Wits Donald Gordon Medical Centre, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa

R Britz, Wits Donald Gordon Medical Centre

Wits Donald Gordon Medical Centre, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa

H Etheredge, Wits Donald Gordon Medical Centre

Wits Donald Gordon Medical Centre and Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

H Maher, Wits Donald Gordon Medical Centre

Wits Donald Gordon Medical Centre and Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

S Bolon, University of the Witwatersrand

Department of Anaesthesia and Critical Care, Charlotte Maxeke Johannesburg Academic Hospital, University of the
Witwatersrand, South Africa

M Eagar, Wits Donald Gordon Medical Centre

Wits Donald Gordon Medical Centre Transplant Anaesthesia, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa

A Beeton, University of the Witwatersrand

Wits Donald Gordon Medical Centre Transplant Anaesthesia, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa

L Brannigan, University of the Witwatersrand

Wits Donald Gordon Medical Centre Transplant Anaesthesia, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa

R Mononyane, Wits Donald Gordon Medical Centre

Wits Donald Gordon Medical Centre Transplant Anaesthesia, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa

S Bannan, Wits Donald Gordon Medical Centre

Wits Donald Gordon Medical Centre Transplant Anaesthesia, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa

M Morford, Wits Donald Gordon Medical Centre

Wits Donald Gordon Medical Centre Transplant Anaesthesia, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa

O Smith, University of the Witwatersrand

Department of Anaesthesia and Critical Care, Charlotte Maxeke Johannesburg Academic Hospital, University of the
Witwatersrand, South Africa

J Fabian, Wits Donald Gordon Medical Centre

Wits Donald Gordon Medical Centre and Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Published
2019-06-27
How to Cite
Botha, J., Ströbele, B., Loveland, J., Rambarran, S., Britz, R., Etheredge, H., Maher, H., Bolon, S., Eagar, M., Beeton, A., Brannigan, L., Mononyane, R., Bannan, S., Morford, M., Smith, O., & Fabian, J. (2019). Living donor liver transplantation in South Africa: the donor experience. South African Journal of Surgery, 57(3), 11-16. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/2998
Section
Transplantation