Introduction: Liver donor hepatectomy is a major surgery that has the potential morbidity and mortality risks among healthy individuals. Therefore, donor safety is the primary concern and it is recommended that complications after living donor surgery should be appropriately documented and evaluated (1,2,3). We presented our cases with pulmonary thromboembolism (PE) among living liver donors after donor hepatectomy in intensive care unit (ICU) during last 5 years.
Case-1: A 48-year-old male donor was admitted to ICU with dyspnea at the postoperative 56th hour. In computed tomographic pulmonary angiography (CTPA), thrombus was detected at the right upper lobar artery. High flow nasal oxygen therapy and non-invasive ventilation (NIV) were started due to moderate hypoxemia. Low molecular weight heparin (LMWH) and warfarin therapy were initiated immediately and he was discharged from hospital on the postoperative 10th day.
Case-2: A 42-year-old male had dispnea and angina at 37th hour after surgery during the ICU stay. LMWH and warfarin therapy were started due to acute massive thrombus in bilateral pulmonary artery branches. He was discharged from the hospital on the postoperative 15th day.
Case-3: A 46-year-old male donor who had dyspnea and hypoxemia at 42th hours after the surgery during the ICU stay, had acute thrombus in the right lower lobar segmental branches of the pulmonary artery in the CTPA. LMWH was started and he was discharged from hospital on the postoperative 21th day.
Case-4: A 29-year-old female who had a 4 previous history of miscarriages was admitted to ICU after donor hepatectomy. At the 20th hour after surgery, she had moderate hypoxemia and acute PE was detected in the lower lobe branches of the right pulmonary artery in the CTPA. LMWH was started and antithrombin III deficiency was found as a risk factor for PE. She was discharged from the hospital on the postoperative 10th day.
Case-5: A 34-year-old male patient had tachycardia, dyspnea and hypoxemia at the postoperative 18th hour in ICU. In CTPA, acute embolism in bilateral pulmonary arteries was detected and LMWH was initiated. Deficiencies of protein C-S, heterozygous methylenetetrahydrofolate reductase (MTHFR) C677T gene mutation and plasminogen activator inhibitor-1 (PAI-1) 4G/5G gene variant were found as risk factors for PE. He was discharged from the hospital on the 6th day with new oral anticoagulant and long term oxygen therapy.
Case-6: A 28-year-old male donor patient had sudden angina and dyspnea 14th hour after surgery in ICU. In his CTPA, acute embolism was detected in the upper lobe of right pulmonary artery and LMWH was initiated. He had deep venous thrombosis (DVT) in his left popliteal vein. He was discharged from the hospital on the postoperative 6th day.
Conclusion: PE among living liver donors after hepatectomy is a serious pulmonary complication. Therefore, among solid organ transplant donors with risk factors for thrombosis during the perioperative period, medical prophylaxis may be essential to prevent thromboembolic complications.