Risk factors of hepatic graft failure, morbidity and mortality after living donor liver transplantation (LDLT): Review Article

Abstract

Back ground: Liver transplantation is a breakthrough in the modern life. With the increase demands on liver transplantation, LDLT was emerged. With more increase in the demands, the donor pool started to be widened and the use of marginal donors started. The factors affect the graft failure become widened and included multiple factors. Aim and objective:This review extensively put the focus on the risk factors for hepatic graft failure after LDLT. Also, the impact of these factors and their influence on the patients' morbidity and mortality. Conclusion:Multiple factors were studied as risk factors for graft failure and patients' mortality after LDLT. The rate of early graft failure is low. This is due to optimum donor selection as regards age, sex, body mass index (BMI) and ABO-compatibility; computer-assisted planning and decision making in donor segmental hepatectomy and optimum GRWR; short cold ischemic time; high level of expertise in the center; and timely detection of vascular, biliary and immunological complications responsible for early graft failure together with early and efficient management. Most of the underlying risk factors for late graft failure include patients with CR which were not responding to treatment and patients with disease recurrence which is unavoidable. Therefore, both these complications constitute real problems in liver transplantation.

Outcomes after liver transplantation in Korea: Incidence and risk factors from Korean transplantation registry

“…The study by Azzam demonstrated ABO-incompatible, the age and sex of the donor, hepatitis B and C virus, HCC as the independent risk factors for graft loss. 17 Our study revealed that increased age of the recipient, DDLT, HCC, acute hepatitis, use of steroids, and use of anti-metabolites were risk factors for graft loss, which are in alignment with several studies published previously. [22][23][24] Thus, it also becomes important that recipients' characteristics, including the underlying liver disease should be considered during management.…”

“…The survival rates at 3-year observed in our study were consistent with recent studies showing superior survival in LDLT recipients than DDLT [ 15 , 16 ]. In alignment with literature, our study also supports that recipient age is a risk factor for survival in LT recipients [ 15 - 17 ]. We observed that LDLT was associated with lower risk of death compared to DDLT.…”

“…15,16 In alignment with literature, our study also supports that recipient age is a risk factor for survival in LT recipients. [15][16][17] We observed that LDLT was associated with lower risk of death compared to DDLT. Several studies have shown better survival outcomes among recipients with LDLT than DDLT 15,16,18 , indicating this as a preferable option for LT.…”

“…A study by Olthoff et al [ 22 ] showed recipient age, hepatitis C virus and HCC as the risk factors for graft loss. The study by Azzam demonstrated ABO-incompatible, the age and sex of the donor, hepatitis B and C virus, HCC as the independent risk factors for graft loss [ 17 ]. Our study revealed that increased age of the recipient, DDLT, HCC, acute hepatitis, use of steroids, and use of anti-metabolites were risk factors for graft loss, which are in alignment with several studies published previously [ 22 - 24 ].…”

Antifibrotic effects of total or partial application of amniotic membrane in hepatic fibrosis

“…Cirrhosis is the worst consequence of liver fibrosis, and the only curative treatment is organ transplantation, which still has several limitations, including scarce availability of liver donors, risk of immune rejection, immunosuppressive therapy for the whole lifetime, the complications of longterm immunosuppression, such as infection and renal failure, and legal, ethical, economic and religious implications. In addition, patients with cirrhosis exhibit a high risk of developing portal hypertension, irreversible liver failure, and hepatocellular carcinoma (meirelis et al 2015, Koyama et al 2016, Jadlowiec and Taner 2016, Azzam 2018, Rawla et al 2018.…”