Excellent Outcome in 238 Consecutive Living Donor Liver Transplantations Using the Right Liver Graft in a Large Volume Single Center

Yi, Nam Joon; Suh, Kyung Suk; Suh, Sanggyun; Chang, Young Soo; Hong, Geun; Yoo, Tae Kyung; Kim, Hye Young; Park, Min Su; Choi, Young Rok; Lee, Kwang Woong; Jung, Chul Woo; Lee, Jeong Hoon; Kim, Yoon Jun; Yoon, Jung Hwan; Lee, Hyo Suk

doi:10.1007/s00268-013-1976-y

Cited by 23 publications

(29 citation statements)

References 38 publications

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“…Living-donor and DCD grafts are at significantly higher risk for biliary complications. [36][37][38][39][40][41] In our series, the overall bile leak rate was 11.6% and the overall biliary stricture rate was 16.4%. When we evaluated the subgroups, the highest rates were observed in the adult LDLT group, with a bile leak rate 13.1% and a biliary stricture rate 23.6% (Table 4).…”

Section: Discussionmentioning

confidence: 48%

Untitled

Yankol

Mecit²,

Kanmaz³

et al. 2016

Exp Clin Transplant

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Objectives: We present here the outcomes of our first 500 liver transplants and discuss the lessons learned during this time. The main cause of chronic liver failure was biliary atresia in pediatric patients (30.4%) and chronic hepatitis B infection in adults (35.6%). The complication rate for primary nonfunction was 3.8%, overall biliary complications 24.0% (significantly higher after adult living-donor liver transplant, 30.3%), hepatic artery thrombosis 1.6%, portal vein thrombosis 3.0%, retransplant 3.8%, acute cellular rejection 29.6%, and bacterial infection 39.4%. Overall 1-, 3-, and 5-year patient survival rates in the first 500 consecutive transplants performed on recipients within United Network for Organ Sharing listing criteria were 87.8%, 85.0%, and 78.6%; for hepatocellular carcinoma patients beyond the Milan criteria, survival rates were 71.9%, 52.5%, and 38.2%. Conclusions:In regions without a sufficient number of deceased donors, living-donor liver transplant, with its associated problems, is the only alternative to deceased-donor liver transplant. Liver transplant requires teamwork, with all players working well together for a successful outcome. The important keys to success in liver transplant include decision-making, timing, surgical skills, experience, and close follow-up.

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Section: Discussionmentioning

confidence: 48%

Untitled

Yankol

Mecit²,

Kanmaz³

et al. 2016

Exp Clin Transplant

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“…Theoretically, the ultimate LDLT should induce no morbidity and mortality in either the donor or recipient. It should at least induce practically no mortality with only limited and temporal morbidity in donors and a short‐term survival rate of ≥90% in recipients, according to the reports from high‐volume centers . The majority of LDLT centers worldwide use RL grafts for most adult LDLT recipients despite concerns regarding possible major complications in donors .…”

Section: Discussionmentioning

confidence: 99%

“…Living donor liver transplantation (LDLT) has become recognized as a treatment of choice for end‐stage liver disease in adults in both Eastern and Western countries during the last 2 decades. However, selection of the graft type (ie, right lobe [RL] or left lobe [LL]) has long been debated in terms of the balance of risks and benefits in donors and recipients . Consequently, most LDLT centers worldwide, except very limited centers, have used RL grafts for more than 90% of LDLT cases in adults because LL grafts are associated with a high risk of small‐for‐size syndrome (SFSS), which may cause graft loss …”

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confidence: 99%

“…However, selection of the graft type (ie, right lobe [RL] or left lobe [LL]) has long been debated in terms of the balance of risks and benefits in donors and recipients. (1)(2)(3)(4)(5) Consequently, most LDLT centers worldwide, except very limited centers, have used RL grafts for more than 90% of LDLT cases in adults because LL grafts are associated with a high risk of small-for-size syndrome (SFSS), which may cause graft loss. (1)(2)(3)(4)(5)(6) Nevertheless, the increased risk of morbidity and mortality of healthy donors after RL donation is not negligible.…”

mentioning

confidence: 99%

“…(1)(2)(3)(4)(5) Consequently, most LDLT centers worldwide, except very limited centers, have used RL grafts for more than 90% of LDLT cases in adults because LL grafts are associated with a high risk of small-for-size syndrome (SFSS), which may cause graft loss. (1)(2)(3)(4)(5)(6) Nevertheless, the increased risk of morbidity and mortality of healthy donors after RL donation is not negligible. (4)(5)(6) The Japanese Liver Transplantation Society survey (7) showed a higher morbidity rate associated with RL than LL donation (19% versus 12%, respectively), and the subsequent report of the Vancouver Forum on the care of live organ donors (8) showed a higher mortality rate associated with RL than LL donation (0.5% versus 0.1%, respectively).…”

mentioning

confidence: 99%

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Left lobe living donor liver transplantation in adults: What is the safety limit?

et al. 2016

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Small-for-size syndrome (SFSS) is the most significant cause of graft loss after living donor liver transplantation (LDLT), especially after left lobe (LL) LDLT in adults. The safety limit of applying LL-LDLT in adults without severe SFSS with a high rate of lethality needs to be determined. A total of 207 LL-LDLTs in adults since September 2005 were evaluated to analyze the risk factors for severe SFSS, defined as a serum total bilirubin concentration of ≥20.0 mg/dL after LDLT. Although there were no significant differences in cumulative graft survival after LDLT between medium grafts (graft volume [GV] to standard liver volume [SLV] ratio ≥ 40.0%), small grafts (35.0% ≤ GV/SLV < 40.0%), and extra small grafts (GV/SLV < 35.0%), patients with severe SFSS showed a significantly lower 5-year graft survival rate than those without (42.9% versus 94.3%, respectively; P < 0.001). Multivariate analysis for severe SFSS after LL-LDLT showed that donor age of ≥48 years (P = 0.01), Model for End-Stage Liver Disease (MELD) score of ≥ 19 (P < 0.01), and end portal venous pressure of ≥19 mm Hg (P = 0.04) were the significant and independent factors for severe SFSS after LL-LDLT. Within such high-risk subgroups of patients with a donor age of ≥48 years or MELD score of ≥ 19 before LDLT, operative blood loss volume of ≥8.0 L was a risk factor for severe SFSS. LL-LDLT in adults could be indicated and provide acceptable outcomes for the combinations of donors aged < 48 years and recipients with a MELD score of <19. Smaller grafts might yield acceptable outcomes in appropriately selected donor-recipient combinations. Liver Transplantation 22 1666-1675 2016 AASLD.

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Reconstruction of hepatic venous tributary in right liver living donor liver transplantation: The importance of the inferior right hepatic vein

et al. 2016

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Special care must be taken in hepatic vein reconstruction to avoid outflow block in living donor liver transplantation (LDLT) with a right liver graft. We have used cryopreserved homologous veins to reconstruct the right hepatic vein (RHV), middle hepatic vein (MHV), MHV tributaries (V5 and V8), and inferior right hepatic vein (IRHV). The reconstruction of V5, V8, and IRHV was based on the estimated congestive volume, calculated by the computed tomography volumetry, to secure the functional graft volume of 40% of the recipient standard liver volume. Among 262 right liver LDLT recipients, the number of reconstructed RHVs, MHVs, V5s, V8s, and IRHVs was 262, 48, 110, 111, and 147, respectively, and the overall patency was 95%, 100%, 36%, 58%, and 86%, respectively. Although the patency of the RHVs and MHVs was satisfactory, that of the V5s, V8s, and IRHVs was suboptimal. Patency of the IRHVs (86%, 126/ 147) was significantly better than that of both V5s (36%, 40/110) and V8s (58%, 64/111; P < 0.001). In addition, the estimated volume drained by IRHVs was significantly greater than that of V5s and V8s (IRHV, 176 6 92 mL; V5, 105 6 49 mL; V8, 127 6 60 mL; P < 0.001). The patency of IRHV was significantly improved by applying the double inferior vena cava method (93%, 94/101) when compared to the direct anastomosis to vena cava (68%, 25/37; P < 0.001). The IRHV functioned as a main drainage route in cases of an obstructed RHV. In conclusion, reconstruction of the IRHV is recommended, not only to improve the functional reserve of the graft, but also to secure multiple drainage routes of the graft.

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Excellent Outcome in 238 Consecutive Living Donor Liver Transplantations Using the Right Liver Graft in a Large Volume Single Center

Cited by 23 publications

References 38 publications

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Left lobe living donor liver transplantation in adults: What is the safety limit?

Reconstruction of hepatic venous tributary in right liver living donor liver transplantation: The importance of the inferior right hepatic vein

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