Increased Surgical Complications but Improved Overall Survival with Adult Living Donor Compared to Deceased Donor Liver Transplantation: A Systematic Review and Meta-Analysis

Tang, Wei; Qiu, Junyi; Cai, Yang; Cheng, Luo; Du, Changsheng

doi:10.1155/2020/1320830

Cited by 21 publications

(19 citation statements)

References 90 publications

(190 reference statements)

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“…Living donor recipients more often experienced biliary complications (31.2 vs. 18.6%, P = .001) relative to deceased donor recipients as has been previously reported. [33][34][35][36][37][38] Living donor recipients also tended to experience these biliary complications at a later time and more often experienced leak rather than stenosis. Risk factors also appeared to deviate between deceased and living donor recipients depending on the complication.…”

Section: Discussionmentioning

confidence: 99%

Surgical complications after living and deceased donor liver transplant: The NSQIP transplant experience

Amara

Parekh

Sudan

et al. 2022

Clinical Transplantation

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This study used the prospective National Surgical Quality Improvement Program (NSQIP) Transplant pilot database to analyze surgical complications after liver transplantation (LT) in LT recipients from 2017to 2019. The primary outcome was surgical complication requiring intervention (Clavien-Dindo grade II or greater) within 90 days of transplant. Of the 1684 deceased donor and 109 living donor LT cases included from 29 centers, 38% of deceased donor liver recipients and 47% of living donor liver recipients experienced a complication. The most common complications included biliary complications (19% DDLT; 31% LDLT), hemorrhage requiring reoperation (14% DDLT; 9% LDLT), and vascular complications (6% DDLT; 9% LDLT). Management of biliary leaks (35.3% ERCP, 38.0% percutaneous drainage, 26.3% reoperation) and vascular complications (36.2% angioplasty/stenting, 31.2% medication, 29.8% reoperation) was variable. Biliary (aHR 5.14, 95% CI 2.69-9.8, P < .001), hemorrhage (aHR 2.54, 95% CI 1.13-5.7, P = .024) and vascular (aHR 2.88, 95% CI .85-9.7, P = .089) complication status at 30-days post-transplant were associated with lower 1-year patient survival. We conclude that biliary, hemorrhagic and vascular complications continue to be significant sources of morbidity and mortality for LT recipients. Understanding the different risk factors for complications between deceased and living donor liver recipients and standardizing complication management represent avenues for continued improvement.

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Section: Discussionmentioning

confidence: 99%

Surgical complications after living and deceased donor liver transplant: The NSQIP transplant experience

Amara

Parekh

Sudan

et al. 2022

Clinical Transplantation

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“…Surgical expertise in this filed has now reached a level of evidence which permits a safe use of graft with biliary variants [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Case report: Trans-papillary free stenting of the cystic duct and of the common bile duct in a double biliary ducts anastomoses of a right lobe living donor transplantation

et al. 2021

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Background One of the major issues related to the living donor liver transplantation recipient outcome is still the high rate of biliary complication, especially when multiple biliary ducts are present and multiple anastomoses have to be performed. Case presentation and conclusion We report a case of adult-to-adult right lobe living donor liver transplantation performed for a recipient affected by alcohol-related cirrhosis with MELD score of 17. End-stage liver disease was complicated by refractory ascites, portal hypertension, small esophageal varices and portal gastropathy, hypersplenism, and abundant right pleural effusion. Here in the attached video we described the adult-to-adult LDLT procedures, where a right lobe with two biliary ducts draining respectively the right anterior and the right posterior segments has been transplanted. LDLT required a biliary reconstruction using the native cystic and common bile ducts stented trans-papillary with two 5- French 6 cm long soft silastic catheter. None major complications were detected during post-operative clinical courses. Actually, the donor and the recipient are alive and well. The technique we describe in the video, allow to keep the biliary anastomoses protected and patent without having the risk of creating cholestasis and the need of invasive additional procedure. No living donor right lobe transplantation should be refused because of the presence of multiple biliary ducts.

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“…Surgical expertise in this led has now reached a level of evidence which permits a safe use of graft with biliary variants (16).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Trans-Papillary Free Stenting of the Cystic Duct and of the Common Bile Duct in A Double Biliary Ducts Anastomoses of A Right Lobe Living Donor Transplantation

Gruttadauria

Tropea

Pagano

et al. 2020

Preprint

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Background One of the major issues related to the living donor liver transplantation recipient outcome is still the high rate of biliary complication, especially when multiple biliary ducts are present and multiple anastomoses have to be performed.Case Presentation and Conclusion We report a case of adult-to-adult right lobe living donor liver transplantation performed for a recipient affected by alcohol-related cirrhosis with MELD score of 17. End-stage liver disease was complicated by refractory ascites, portal hypertension, small esophageal varices and portal gastropathy, hypersplenism, and abundant right pleural effusion. Here in the attached video we described the adult-to-adult LDLT procedures, where a right lobe with two biliary ducts draining respectively the right anterior and the right posterior segments has been transplanted. LDLT required a biliary reconstruction using the native cystic and common bile ducts stented trans-papillary with two 5- French 6 cm long soft silastic catheter. None major complications were detected during post-operative clinical courses. Actually, the donor and the recipient are alive and well.The technique we describe in the video, allow to keep the biliary anastomoses protected and patent without having the risk of creating cholestasis and the need of invasive additional procedure. No living donor right lobe transplantation should be refused because of the presence of multiple biliary ducts.

show abstract

Increased Surgical Complications but Improved Overall Survival with Adult Living Donor Compared to Deceased Donor Liver Transplantation: A Systematic Review and Meta-Analysis

Cited by 21 publications

References 90 publications

Surgical complications after living and deceased donor liver transplant: The NSQIP transplant experience

Surgical complications after living and deceased donor liver transplant: The NSQIP transplant experience

Case report: Trans-papillary free stenting of the cystic duct and of the common bile duct in a double biliary ducts anastomoses of a right lobe living donor transplantation

Case Report: Trans-Papillary Free Stenting of the Cystic Duct and of the Common Bile Duct in A Double Biliary Ducts Anastomoses of A Right Lobe Living Donor Transplantation

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