Pulmonary Embolism Following Living Donor Hepatectomy: A Report of 4 Cases and Literature Review.

Abstract

BACKGROUND Living donor liver transplantation (LDLT) is an established treatment for end-stage liver disease, where donor safety remains a top priority. Pulmonary embolism (PE) is an unpredictable but serious complication following liver donor hepatectomy (LDH), contributing significantly to postoperative morbidity and mortality. CASE REPORT This article reports 4 cases of PE in living donors following LDH, discussing their clinical presentations, diagnosis, and treatment, and reviewing the relevant literature. Patient 1 was a 46-year-old man who underwent laparotomy right hepatectomy and developed PE on postoperative day (POD) 2. Patient 2 was a 42-year-old woman who donated the left half liver for her son. On POD 8, she was diagnosed with PE by enhanced computed tomography (CT) scan. Patient 3 was a 65-year-old man with 2 years history of hypertension. He underwent a laparotomy right hepatectomy and developed PE on POD 2. Patient 4 was a 57-year-old woman who underwent laparotomy left hepatectomy with the middle hepatic vein. On POD 3, the patient suddenly developed dyspnea after ambulation, and the enhanced CT of pulmonary arteries showed extensive PE in both lungs. All donors developed symptoms such as dyspnea and hypoxemia postoperatively, and were diagnosed with PE through imaging studies. Prompt anticoagulation therapy led to favorable outcomes in all cases. CONCLUSIONS Although PE is a rare and serious complication after LDH, early recognition and timely intervention are crucial to prevent catastrophic outcomes for the donor. Improving perioperative management is key to enhancing donor safety.