Ann Hepatobiliary Pancreat Surg.  2017 Nov;21(4):232-236. 10.14701/ahbps.2017.21.4.232.

Diaphragmatic herniation following donor hepatectomy for living donor liver transplantation: a serious complication not given due recognition

• Lochan R
• Saif R
• Ganjoo N
• Sakpal M
• Panackal C
• Raja K
• Reddy J
• Asthana S
• Jacob M

• KMID: 2397805
• DOI: http://doi.org/10.14701/ahbps.2017.21.4.232

Abstract

A clear appreciation of benefits and risks associated with living donor hepatectomy is important to facilitate counselling for the donor, family, and recipient in preparation for living donor liver transplant (LDLT). We report a life-threatening complication occurring in one of our live liver donors at 12 weeks following hemi-liver donation. We experienced five donor complications among our first 50 LDLT: Clavien Grade 1, n=1; Clavien grade 2, n=3; and Clavien grade 3B, n=1. The one with Clavien grade 3B had a life-threatening diaphragmatic hernia occurring 12 weeks following hepatectomy. This was promptly recognized and emergency surgery was performed. The donor is well at 1-year follow-up. Here we provide a review of reported instances of diaphragmatic hernia following donor hepatectomy with an attempt to elucidate the pathophysiology behind such occurrence. Life-threatening donor risk needs to be balanced with recipient benefit and risk on a tripartite basis during the counselling process for LDLT. With increasing use of LDLT, we need to be aware of such life-threatening complication. Preventive measures in this regard and counselling for such complication should be incorporated into routine work-up for potential live liver donor.

Keyword

Minimizing donor risk; Living liver donor hepatectomy; Liver transplantation; Diaphragmatic hernia

MeSH Terms

Emergencies
Follow-Up Studies
Hepatectomy*
Hernia, Diaphragmatic
Humans
Liver Transplantation*
Liver*
Living Donors*
Risk Assessment
Tissue Donors*

Figure

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  Fig. 1 Panel demonstrating coronal reconstructions of CT scan. The right colon and small intestine loops are into the right chest, herniating through a narrow defect in the right diaphragm with “a swirl sign”.

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