Donor and recipient outcomes in right lobe adult living donor liver transplantation

Abstract

Severe donor organ shortage has provided the impetus for adult living donor liver transplantation (ALDLT).Despite rapid implementation and expansion of the procedure, outcome analysis of ALDLT is still incomplete. This study analyzed both donor and recipient outcomes after ALDLT at a single center. ALDLT performed at UCLA between August 1999 and November 2001 were reviewed retrospectively. Twenty recipients (14 men and 6 women) with a mean age of 48.8 f 9.7 (29 to 66) years underwent right lobe ALDLT. By computed tomograpy (CT), grafdrecipient weight ratio (GRWR) was 1.3 f 0.3 ( 1 to 2.2). Overall l-year patient and graft survival rates were 95% and 85%, respectively. One recipient died of heart failure with normal liver function 5 months after transplantation. Three grafts (14%) were lost and all three patients underwent successful cadaveric retransplantation. Complications were classified according to the Clavien grading system with all but 3 recipients encountering at least one complication. Nine (45%) had grade 1 (minor), 10 (50%) had grade 2 (potentially life threatening without residual disease/disability), 3 (14%) had grade 4A (retransplantation) and one grade 4B (death). Right lobectomy for living donation was performed in 20 patients (12 men, 8 women). Residual left lobe volumes were 36 f 5.3 (23.9 to 47.9)% of total donor liver volume. No donor required intensive care unit admission and median hospital stay was 7.5 (6 to 14) days. One donor was aborted after intraoperative biopsy showed > 50% macrovesicular steatosis. No donor mortality or long-term complications were encountered. Five grade 1 minor complications, by Clavien Classification, occurred in 4 of 20 (20%) donors. ALDLT using right lobe grafts is an effective procedure to expand a severely depleted donor, but is associated with a high complication rate despite good survival outcomes. Continuous standardized reporting of ALDLT outcomes is required to allow successful and safe implementation of the procedure. (Liver Tramp22002;8: 901-909.)

Live Donors in Liver Transplantation

“…Biliary complications, either bile leak or stricture at the anastomotic site or cut edge of the transected liver were reported in 15% -60% of recipients in early, single center reports [21][22][23][24] . Stenting the biliary anastomosis has been used to attempt to reduce the rate of bile leaks and strictures, but it is of unproven benefit.…”

Donor Morbidity After Living Donation for Liver Transplantation

“…The rates of complications in these single center publications ranged from as low as 9% to as high as 67%. 11,[13][14][15][16][17][18][19][20][21] In a national survey from North America, the overall donor complication rate was reported to be only 10%. 22 The lack of uniformity in defining complications and underreporting of technical complications, blood and blood product transfusions, and aborted donations all contribute to the lack of firm information about the risks of right lobe liver donation.…”

Accelerated hepatitis C virus kinetics but similar survival rates in recipients of liver grafts from living versus deceased donors

“…1 Several studies have compared outcomes of LD liver transplantation (LDLT) and DDLT in HCV patients. [2][3][4][5][6][7][8][9][10][11] Results have been inconsistent, in part, because of differences in experimental design and small sample sizes. [12][13][14][15][16][17] Concerning survival, no short-term difference was observed in a study of 65 DD versus 35 LD patients, 6 and analysis of the United Network for Organ Sharing liver transplant database showed that the 2-year survival of 279 LD and 3,955 DD recipients was virtually identical.…”