Balanced approach can help initial outcomes: analysis of initial 50 cases of a new liver transplantation program in East Asia

Abstract

PurposeTo evaluate patient triage pattern and outcomes according to types of liver transplantation as part of a new liver transplant program developed in an East Asian country with a limited number of deceased donors.MethodsMedical records of initial 50 liver transplantations were reviewed retrospectively.ResultsTwenty-nine patients underwent deceased donor liver transplantation (DDLT) and 21 patients underwent living donor liver transplantation (LDLT). Mean model for end-stage liver disease scores of recipients of DDLT and LDLT were 24.9 ± 11.6 and 13.1 ± 5.4, respectively (P < 0.0001). Twenty-eight patients had HCCs and 17 of them (60.7%) underwent LDLT, which was 80.9% of LDLTs. There were 2 cases of perioperative mortality; each was from DDLT and LDLT, respectively. Median follow-up was 18 months. Overall patient and graft survival rates at 6 months, 1 and 2 years were 95.7%, 93.4%, and 89.8%, respectively. There was no significant difference in survival between DDLT and LDLT. Overall recurrence-free survival rates of hepatocellular carcinoma (HCC) patients at 6 month, 1, and 2 years were 96.3%, 96.3%, and 90.3%, respectively. There was no significant difference in recurrence-free survival between DDLT and LDLT.ConclusionAs a new liver transplant program with limited resource and waiting list, patients with critical condition could undergo DDLT whereas relatively stable patients with HCCs were mostly directed to LDLT. We recommend a balanced approach between DDLT and LDLT for initiating liver transplant programs.

Outcomes of the Initial Phase of an Adult Living versus Deceased Donor Liver Transplantation Program in a Low-volume Transplant Center

“…Many studies have shown excellent LDLT outcomes in countries that have low DDLT rates. [2,11] For these reasons, a successful DDLT program does not always result in successful LDLT procedures. On the other hand, a high-volume hepatobiliary center with extensive experience in complex liver resection may have the opportunity to successfully develop LDLT programs.…”