Journal article
Left-liver Adult-to-Adult Living Donor Liver Transplantation: Can It Be Improved? A Retrospective Multicenter European Study.
- Sánchez-Cabús S Department of HPB Surgery and Transplantation, Hospital Clínic de Barcelona. CIBEREHD. Barcelona, Spain.
- Cherqui D Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France.
- Rashidian N Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital and Medical School, Ghent, Belgium.
- Pittau G Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France.
- Elkrief L Division of Transplantation, Department of Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
- Vanlander A Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital and Medical School, Ghent, Belgium.
- Toso C Division of Transplantation, Department of Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
- Fondevila C Department of HPB Surgery and Transplantation, Hospital Clínic de Barcelona. CIBEREHD. Barcelona, Spain.
- Cunha AS Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France.
- Berney T Division of Transplantation, Department of Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
- Castaing D Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France.
- de Hemptinne B Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital and Medical School, Ghent, Belgium.
- Fuster J Department of HPB Surgery and Transplantation, Hospital Clínic de Barcelona. CIBEREHD. Barcelona, Spain.
- Rogiers X Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital and Medical School, Ghent, Belgium.
- Adam R Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France.
- Majno P Division of Transplantation, Department of Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
- García-Valdecasas JC Department of HPB Surgery and Transplantation, Hospital Clínic de Barcelona. CIBEREHD. Barcelona, Spain.
- Troisi RI Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital and Medical School, Ghent, Belgium.
- 2018-08-07
Published in:
- Annals of surgery. - 2018
Adult
Europe
Female
Graft Survival
Humans
Liver Function Tests
Liver Transplantation
Living Donors
Male
Middle Aged
Postoperative Complications
Retrospective Studies
Risk Factors
Treatment Outcome
English
OBJECTIVE
To evaluate the European experience after Adult-to-adult living donor liver transplantation using the left liver (LL-aLDLT).
SUMMARY BACKGROUND DATA
LL-aLDLT decreases donor risk but provides a smaller graft that increases recipient risk as compared with right liver (RL-aLDLT). However, there is little knowledge of results obtained after LL-aLDLT in Europe.
METHODS
This is a European multicenter retrospective study which aims to analyze donor and recipient outcomes after 46 LL-aLDLT.
RESULTS
Seventy-six percent of the grafts were harvested by minimally invasive approach. Mean donor hospital stay was 7.5 ± 3.5 days. Donor liver function was minimally impaired, with 36 donors (78.3%) without any 90-day complication, and 4 (8.7%) presenting major complications. One, 3, and 5-year recipient survival was 90.9%, 82.7%, and 82.7%, respectively. However, graft survival was of 59.4%, 56.9%, and 56.9% at 1, 3, and 5 years respectively, due to a 26.1% urgent liver retransplantation (ReLT) rate, mainly due to SFSS (n = 5) and hepatic artery thrombosis (HAT, n = 5). Risk factor analysis for ReLT and HAT showed an association with a graft to body weight ratio (GBWR) <0.6% (P = 0.01 and P = 0.024, respectively) while SFSS was associated with a recipient MELD ≥14 (P = 0.019). A combination of donor age <45 years, MELD <14 and actual GBWR >0.6% was associated with a lower ReLT rate (0% vs. 33%, P = 0.044).
CONCLUSIONS
Our analysis showed low donor morbidity and preserved liver function. Recipient outcomes, however, were hampered by a high ReLT rate. A strict selection of both donor and recipients is the key to minimize graft loss.
To evaluate the European experience after Adult-to-adult living donor liver transplantation using the left liver (LL-aLDLT).
SUMMARY BACKGROUND DATA
LL-aLDLT decreases donor risk but provides a smaller graft that increases recipient risk as compared with right liver (RL-aLDLT). However, there is little knowledge of results obtained after LL-aLDLT in Europe.
METHODS
This is a European multicenter retrospective study which aims to analyze donor and recipient outcomes after 46 LL-aLDLT.
RESULTS
Seventy-six percent of the grafts were harvested by minimally invasive approach. Mean donor hospital stay was 7.5 ± 3.5 days. Donor liver function was minimally impaired, with 36 donors (78.3%) without any 90-day complication, and 4 (8.7%) presenting major complications. One, 3, and 5-year recipient survival was 90.9%, 82.7%, and 82.7%, respectively. However, graft survival was of 59.4%, 56.9%, and 56.9% at 1, 3, and 5 years respectively, due to a 26.1% urgent liver retransplantation (ReLT) rate, mainly due to SFSS (n = 5) and hepatic artery thrombosis (HAT, n = 5). Risk factor analysis for ReLT and HAT showed an association with a graft to body weight ratio (GBWR) <0.6% (P = 0.01 and P = 0.024, respectively) while SFSS was associated with a recipient MELD ≥14 (P = 0.019). A combination of donor age <45 years, MELD <14 and actual GBWR >0.6% was associated with a lower ReLT rate (0% vs. 33%, P = 0.044).
CONCLUSIONS
Our analysis showed low donor morbidity and preserved liver function. Recipient outcomes, however, were hampered by a high ReLT rate. A strict selection of both donor and recipients is the key to minimize graft loss.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1097/SLA.0000000000002897
- PMID 30080732
- Persistent URL
- https://sonar.ch/global/documents/46638
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