Systematic Medical Record Review to Identify Safety Risks in Living Liver Donors
1Northwestern University, Chicago, IL
2Virginia Commonwealth University, Richmond, VA
3Columbia University, New York, NY
4Lahey Clinic, Boston, MA
5CHS, Northwestern University, Chicago, IL.
Meeting: 2015 American Transplant Congress
Abstract number: B162
Keywords: Adverse effects, Living-related liver donors, Outcome, Safety
Session Information
Session Name: Poster Session B: Liver: Living Donors
Session Type: Poster Session
Date: Sunday, May 3, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
BACKGROUND
Prevention of adverse events (AEs) is important in Living Donor Liver Transplantation (LDLT), as these are healthy volunteers who undergo a major procedure with no medical benefit to themselves. Identification of AEs related to living liver donation are important to inform critical targets for safety improvement in LDLT patient care. Historically, in depth medical record (MR) reviews were needed to identify AEs, which is time-consuming, requiring a high skill level and resources. Institute for Healthcare Improvement (IHI) developed a Global Trigger Tool (GTT) to assess AEs, but this tool is limited and lacks clear definitions of complications and guidance to interpret results. We aim to develop a modified GTT that improves precision, simplifies use for LDLT programs with the personnel at hand and provides an excellent tool to improve living liver donor outcomes.
METHODOLOGY
MRs were collected from 4 of 9 Adult to Adult Living Donor Liver Transplantation Cohort (A2ALL) centers from 2008-2010. MRs included documentation from LDLT admission to discharge and any readmission within 30 days. A multidisciplinary team (transplant surgeon, physician scientist, nurses, medical student) modified the GTT to include transplant specific AEs and created precise clinical definitions based on literature and were compiled in a codebook. MRs were reviewed by 2 raters (MD, medical student).
RESULTS
MR reviews of 91 donors were conducted. The mean age was 39; 57% male, 77% Caucasian, 19% Hispanic or black, 93% English speaking. 722 AEs were identified in 91 MRs (mean 7.8/patient (2-19). Of these, 29% had 5-7 AEs and 14% had 12-14 AEs. The percentage of patients who experienced each of the most frequent AEs were: nausea (68%), constipation (67%), hypoxia (64%), anemia (46%), respiratory depression (46%), tachypnea (46%), hypotension (42%), atelectasis (41%), pleural effusion (41%), fever (37%). The time per MR was 60min. Inter-rater reliability was > 0.9.
DISCUSSION
The enhanced GTT is a simple tool to examine AEs in living liver donors that can be reliably used with minimal training. AEs are far more prevalent than previously reported. Better understanding of AEs in living liver donors is paramount to improving their safety in the future.
To cite this abstract in AMA style:
Platt B, Woods D, Fisher R, Guarrera J, Pomfret E, Simpson M, Daud A, Curtis T, Reyes E, Wymore E, Skaro A, Ladner D. Systematic Medical Record Review to Identify Safety Risks in Living Liver Donors [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/systematic-medical-record-review-to-identify-safety-risks-in-living-liver-donors/. Accessed May 11, 2025.« Back to 2015 American Transplant Congress