ABSTRACT
BACKGROUND: Comprehensive assessment of quality of life of live liver donors is required for adequate donor outcome reporting, but there is a lack of prospective data. Assessment of all aspects of liver donation over a long period is a necessity to have complete understanding of the donation process. METHODS: Prospectively collected data of liver donors operated between March 2012 to August 2013, examined donors (n = 52) from predonation to five years after the donation. Participants were administered 'World Health Organization quality of life Brief and questionnaires' regarding their attitude predonation, their overall well-being in terms of abdominal symptoms, cosmesis, and satisfaction with donation and consent process at predefined time points till five years after donation. The weight of the donors was recorded at predefined time points. RESULTS: The donors whose recipients died were less likely to continue with the study (8.9% vs. 71.4%; P < 0.001). After surgery, physical domain took 2 years to reach to predonation level while psychological and social relationship domains took 3 months and 1 month, respectively; environmental domain remained stable throughout. Even after recovery and discharge from hospital, donors experienced abdominal symptoms for a long period of time, but as the time increased from donation the reporting of symptoms decreased. Body image scores (12 ± 2.46 at 3 months vs. 14.9 ± 3.16 at five years, P < 0.001) and cosmesis scores (14.6 ± 3.67 at 3 months vs. 18.75 ± 3 at five years, P < 0.001) significantly improved over time. There was significant weight gain in donors (65.2 ± 6.1 kg predonation vs. 70.69 ± 2.4 kg at 2 years P < 0.001). Donors understood the consent process well, but did not use it for decision making. Overall, they showed a high level of satisfaction in the donation process. CONCLUSION: Donors have good quality of life and show steady recovery in all aspects. Recipient death affects attitude towards donation process.
ABSTRACT
BACKGROUND AND AIMS: Hepatic resection is a major surgery associated with intraoperative massive fluid shifts, blood loss, haemodynamic instability and risk of development of post-hepatectomy liver failure. Hepatic resection predisposes the patient to coagulopathy as well as venous thrombosis. However, due to the development of deranged coagulation profile post-operatively, there is a dilemma in starting thromboprophylaxis. Our aim in this study was to determine the incidence of coagulopathy in patients undergoing major hepatectomy. METHODS: In this retrospective study, we included 86 patients who had undergone major hepatectomy between January 2010 and December 2015 at our centre. Intraoperatively, we noted the number of liver segments resected, details of epidural catheter insertion, estimated blood loss, transfusion requirement and need for mechanical ventilation post-operatively. Trends of international normalised ratio (INR) and platelet values were recorded until post-operative day 5. RESULTS: Of the 86 patients, 6 (7%) had an abnormal coagulation profile pre-operatively and 39 (45.34%) patients developed a derangement in their coagulation profile on 1st post-operative day (POD). Platelet count was significantly lower and INR values were significantly higher than the pre-operative values on all 5 PODs. Sixty-seven (78%) patients had pre-operative epidural catheter insertion for post-operative pain management. Mechanical thrombophylaxis was used routinely. CONCLUSIONS: The incidence of post-operative coagulopathy in our patients who underwent major liver resection was 45.34%. Epidural catheters could be removed safely without transfusion between POD 5 and 7. There was no incidence of venous thrombosis or thromboembolism.
