1
|
Lauterio A, Di Sandro S, Gruttadauria S, Spada M, Di Benedetto F, Baccarani U, Regalia E, Melada E, Giacomoni A, Cescon M, Cintorino D, Ercolani G, Rota M, Rossi G, Mazzaferro V, Risaliti A, Pinna AD, Gridelli B, De Carlis L. Donor safety in living donor liver donation: An Italian multicenter survey. Liver Transpl 2017; 23:184-193. [PMID: 27712040 DOI: 10.1002/lt.24651] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/28/2016] [Accepted: 08/31/2016] [Indexed: 12/12/2022]
Abstract
Major concerns about donor morbidity and mortality still limit the use of living donor liver transplantation (LDLT) to overcome the organ shortage. The present study assessed donor safety in LDLT in Italy reporting donor postoperative outcomes in 246 living donation procedures performed by 7 transplant centers. Outcomes were evaluated over 2 time periods using the validated Clavien 5-tier grading system, and several clinical variables were analyzed to determine the risk factors for donor morbidity. Different grafts were obtained from the 246 donor procedures (220 right lobe, 10 left lobe, and 16 left lateral segments). The median follow-up after donation was 112 months. There was no donor mortality. One or more complications occurred in 82 (33.3%) donors, and 3 of them had intraoperative complications (1.2%). Regardless of graft type, the rate of major complications (grade ≥ 3) was 12.6% (31/246). The overall donor morbidity and the rate of major complications did not differ significantly over time: 26 (10.6%) donors required hospital readmission throughout the follow-up period, whereas 5 (2.0%) donors required reoperation. Prolonged operative time (>400 minutes), intraoperative hypotension (systolic < 100 mm Hg), vascular abnormalities, and intraoperative blood loss (>300 mL) were multivariate risk factors for postoperative donor complications. In conclusion, from the standpoint of living donor surgery, a meticulous and well-standardized technique that reduces operative time and prevents blood loss and intraoperative hypotension may reduce the incidence of donor complications. Transparency in reporting results after LDLT is mandatory, and we should continue to strive for zero donor mortality. Liver Transplantation 23 184-193 2017 AASLD.
Collapse
Affiliation(s)
- Andrea Lauterio
- Transplant Center, Division of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano Di Sandro
- Transplant Center, Division of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Experimental Medicine, University of Pavia, Pavia, Italy
| | - Salvatore Gruttadauria
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione-University of Pittsburgh Medical Center, Palermo, Italy
| | - Marco Spada
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione-University of Pittsburgh Medical Center, Palermo, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Italy
| | - Umberto Baccarani
- Liver Transplant Unit, Department of Medical and Biological Sciences, University Hospital, Udine, Italy
| | - Enrico Regalia
- Hepato-Pancreato-Biliary Surgery and Liver Transplant Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Ernesto Melada
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Maggiore Hospital, Milan, Italy
| | - Alessandro Giacomoni
- Transplant Center, Division of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Cescon
- Abdominal Organ Transplant Center, Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, Bologna, Italy
| | - Davide Cintorino
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione-University of Pittsburgh Medical Center, Palermo, Italy
| | - Giorgio Ercolani
- Abdominal Organ Transplant Center, Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, Bologna, Italy
| | - Matteo Rota
- Department of Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Giorgio Rossi
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Maggiore Hospital, Milan, Italy
| | - Vincenzo Mazzaferro
- Hepato-Pancreato-Biliary Surgery and Liver Transplant Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Andrea Risaliti
- Liver Transplant Unit, Department of Medical and Biological Sciences, University Hospital, Udine, Italy
| | - Antonio Daniele Pinna
- Abdominal Organ Transplant Center, Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, Bologna, Italy
| | - Bruno Gridelli
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione-University of Pittsburgh Medical Center, Palermo, Italy
| | - Luciano De Carlis
- Transplant Center, Division of General Surgery and Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,School of Medicine, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
4
|
Shio S, Yazumi S, Ogawa K, Hasegawa K, Tsuji Y, Kida M, Yamauchi J, Ida H, Tada S, Uemoto S, Chiba T. Biliary complications in donors for living donor liver transplantation. Am J Gastroenterol 2008; 103:1393-8. [PMID: 18510614 DOI: 10.1111/j.1572-0241.2008.01786.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES With the increasing number of living donor liver transplantations, biliary complications in donors have emerged as a major postoperative problem. The aim of the present study was to characterize the features of the biliary complications that occur in donors. METHODS The study subjects comprised 731 consecutive patients who donated liver grafts (434 right-lobe and 297 left-lobe grafts) for transplantation at Kyoto University Hospital from July 1999 to December 2006. Donors whose biliary complications could not be cured by conservative therapy were referred for endoscopic treatment. RESULTS Postoperative biliary complications occurred in 55 (7.5%) donors. Initially, 48 of these 55 donors had biliary leakage and 7 had biliary stricture. Subsequently, 5 of 48 donors with leakage developed biliary stricture. The respective incidences of biliary leakage and overall biliary complications were significantly higher among donors of right-lobe grafts (9.9% and 11.1%) than among donors of left-lobe grafts (1.7% and 2.4%). Among 55 donors with biliary complications, 24 were cured by conservative therapy, and 1 was converted to surgical repair due to ileus. Endoscopic treatment was successful in 24 of 30 (80%) donors treated by endoscopic retrograde cholangiography, while the remaining 6 (20%) patients underwent surgery due to difficulties with cannulation (N = 2), excessive biliary leakage (N = 2), or complete biliary obstruction (N = 2). CONCLUSIONS Donors of right-lobe grafts have a significantly higher incidence of biliary complications than donors of left-lobe grafts. When conservative therapy fails, endoscopic treatment is effective for these complications, and should be attempted as the first-line therapy before surgical repair.
Collapse
Affiliation(s)
- Seiji Shio
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Abstract
The inequality between supply of grafts and demand for transplants has forced the transplant community to devise ways to increase the number of available livers for transplant (ie, through use of extended criteria donor grafts and living donation). Since 2002, the number of live donor liver transplantations (LDLT) performed has declined due to concerns of donor safety and lack of clear outcome data establishing success equivalent to that of deceased donor liver transplantation (DDLT). Recent data suggest that LDLT outcomes are comparable with those of DDLT, provided a center has performed more than 20 procedures, both in patients with and without hepatitis C. Further studies are needed to define the optimal donor and the ideal recipient for LDLT. Results from a National Institutes of Health-funded consortium of nine transplant centers are highly anticipated. These data are expected to underscore the viability of LDLT as a life-saving therapy for certain patients with end-stage liver disease.
Collapse
Affiliation(s)
- Sonja K Olsen
- Columbia University College of Physicians and Surgeons, Center for Liver Disease and Transplantation, New York-Presbyterian Hospital, 622 West 168th Street, PH 14 Center, New York, NY 10032, USA
| | | |
Collapse
|
6
|
Emiroglu R, Sevmis S, Moray G, Savas N, Haberal M. Living-donor liver transplantation: results of a single center. Transplant Proc 2007; 39:1149-52. [PMID: 17524917 DOI: 10.1016/j.transproceed.2007.02.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In the absence of cadaveric donor liver transplantation, living-donor liver transplantation (LDLT) is an alternative option for patients with end-stage liver disease. The objective of this study was to evaluate the outcome of LDLT at a single medical center in Turkey. We retrospectively analyzed the results of 101 LDLTs in 99 recipients with end-stage liver disease. We transplanted 49 right liver lobes, 16 left lobes, and 36 hepatic segments II and III. Most donors (46%) were parents of the recipients. Seventeen recipients had concomitant hepatocellular carcinoma and cirrhosis. Retransplantation was performed in two recipients. Ten hepatic arterial thromboses, 1 hepatic arterial bleeding, and 12 biliary leaks occurred in the early postoperative period. Most complications were treated with interventional techniques. Three hepatic vein stenoses, three portal vein stenoses, one hepatic arterial stenosis, and six biliary stenoses developed during the late postoperative period. Recipients with those complications were treated with interventional techniques. Mean follow-up was 14.2 +/- 10.9 months. During that time, no tumor recurrence was detected in any recipient with hepatocellular carcinoma. Twenty-two recipients died during the follow-up. At this time, the remaining 77 recipients (77%) are alive, exhibiting good graft function. In general, complication rates are slightly higher after LDLT than after cadaveric liver transplantation. However, most complications can be treated with interventional techniques. LDLT continues to be a life-saving option in countries without satisfactory cadaveric donation rates.
Collapse
Affiliation(s)
- R Emiroglu
- Department of General Surgery, Baskent University Faculty of Medicine, Ankara, Turkey
| | | | | | | | | |
Collapse
|
7
|
Jr WTP, Lee KH, Tay KH, Wong SY, Singh R, Leong SO, Tan KC. Adult Living Donor Liver Transplantation in Singapore: The Asian Centre for Liver Diseases and Transplantation Experience. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2007. [DOI: 10.47102/annals-acadmedsg.v36n8p623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Introduction: Living donor liver transplantation (LDLT) has progressed dramatically in Asia due to the scarcity of cadaver donors and is increasingly performed in Singapore. The authors present their experience with adult LDLT.
Materials and Methods: Adult LDLTs performed at the Asian Centre for Liver Diseases and Transplantation, Singapore from 20 April 2002 until 20 March 2006 were reviewed. All patients received right lobe grafts and were managed by the same team throughout this period. Data were obtained by chart review. This study presents both recipient and donor outcomes in a single centre.
Results: A total of 65 patients underwent LDLT. Forty-three were genetically related while 22 were from emotionally-related donors. The majority were chronic liver failure while 14% were acute. The most common indication for LDLT was end-stage liver disease due to hepatitis B virus. A total of 22 patients with hepatoma were transplanted and overall 1-year disease specific survival was 94.4%. The mean model for end-stage liver disease (MELD) score was 17.4 ± 9.4 (range, 6 to 40). Six patients had preoperative molecular adsorbent recycling system (MARS) dialysis with 83% transplant success rate. The mean follow-up was 479.2 days with a median of 356 days. One-year overall survival was 80.5%. There was 1 donor mortality and morbidity rate was 17%. Our series is in its early stage with good perioperative survival outcome with 1-month and 3-month actuarial survival rates of 95.4% and 87.3% respectively.
Conclusion: The study demonstrates that LDLT can be done safely with good results for a variety of liver diseases. However, with dynamically evolving criteria and management strategies, further studies are needed to maximise treatment outcome.
Key words: Donor and recipient outcome, End-stage liver disease, Hepatitis, Hepatocellular carcinoma, Living donor liver transplantation
Collapse
|