Near-miss events during donor left liver lobe hepatectomy: A potential quality-control to assess donor safety in living donor liver transplantation programs

Bonaccorsi Riani, Eliano;Daudré-Vignier, Victoria;Ciccarelli, Olga;Coubeau, Laurent;Reding, Raymond;et.al.
(2019) 2019 American Transplant Congress, ATC 2019 — Location: Boston, MA,United States (1.June.2019)

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Purpose: Living donor liver transplantation (LDLT) is a well-established alterna-tive to alleviate postmortem organ shortage in pediatric liver transplantation. Such program, however, should be performed under strict ethical guidelines, and optimal living donor (LD) safety. In spite of left lobe or left lateral liver resection are very standardizedsurgical procedures in pediatric LDLT Zprograms with minimal morbidity and almost no mortality, we hypothesized that serious unexpected peri-operative medical and/or surgical events during LD procedure indeed occur in a high volume LDLT Zcenter, being a major threat to donor safety. Methods: From July 1993 to October 2018, 433 paediatric LDLT Zwere perfotmed in our institution under a very strict ethical and clinical protocol. LD medical records were retrospectively reviewed searching for preoperatory donor data, surgical and outcome and the occurrence of perioperative near-miss events (NME). NME was defined as any potentially perioperative hamrful event that was identified and con-trolled before definitive patient or recipient harm has happened. Results: There was no mortality in our series. Morbidity consisted mainly in cut-surface collections, transient pleural effusions, in less than 3% each and few incisional hernias. Eight (1, 8%) intraoperative NME occurred in LDs: accidental vena cava clamp releasing, left hepatic artety (HA) clip sliding both resulting in massive intraoperative bleeding, donor right HA ligature and section, accidental section of left HA at liver graft Mum, tension pneumothorax during right sub-clavian vein catheterization, LD intravenous full-heparinization before left portal vein clamping, section of donor common hepatic duct, injury of segment II bile duct at the graft cut surface. NME management consisted in: vascular control of intraoperative bleeding and microsurgical repair of arterial lesions, pneumothorax drainage, intravenous protamine administration, Roux-en-Y hepaticojejunostomy reconstruction, repair of segment II bile duct injury at back-table. None of these NME resulted in postoperative morbidity. Conclusions: Despite our minimal morbidity and no mortality rates, unexpected potentially life-threating intraoperative events occurred in our 433 left lobe hepa-tectomies. 8 serious and potential harmful NMEs were identified in this series. All NME were timely recognised and controlled without subsequent donor or recipient lasting harm. NMEs systematic debriefing led to safety refinements in our LD pro-tocol. Systematic record of LD/NME may be used as quality control tool to assess donor safety in LDLT Zprograms.
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Bonaccorsi Riani, E., Daudré-Vignier, V., Ciccarelli, O., Coubeau, L., Iesari, S., Tambucci, R., De Magnée, C., Pire, A., & Reding, R. (2019). Near-miss events during donor left liver lobe hepatectomy: A potential quality-control to assess donor safety in living donor liver transplantation programs. American Journal of Transplantation. Supplement, 3, 878. https://hdl.handle.net/2078.5/218608 (Original work published 2019)