A Decade of Right Liver Adult-to-Adult Living Donor Liver Transplantation
Summary Background Data: To define the donor risk and recipient benefit ratio, midterm outcome of this life-saving treatment modality ought to be known.
Methods: Consecutive patients from 9 May 1996 were included. Era I comprised the first 50 patients and Era II comprised the remaining 184 patients. Their midterm outcomes were compared with patients receiving deceased donor liver transplantation (DDLT) of the same period in the same center.
Results: With a median follow-up of 48 months, the 1-, 3-, and 5-year overall survival rates were 93.2%, 85.7%, and 82.4%, respectively and were comparable with those of DDLT (n = 131) (90.1%, 87.7%, and 85.2%) (P = 0.876). Hospital mortality decreased from 16% in Era I to 2.2% in Era II (P = 0.000). Reduced hospital mortality improved the overall survival rates from Era I to Era II (78%, 74%, and 72% vs. 97.3%, 88.7%, and 85.1%, respectively) (P = 0.003). The 5-year survival rate of recipients with hepatocellular carcinoma (HCC) (n = 65) was 65.7%. Starting from Era II, excellent 5-year survival of recipients without HCC was achieved as compared with DDLT in the same period (93.4% vs. 88.2%) (P = 0.493). The 5-year survival rates of recipients with HCC within the Milan criteria of Era II and DDLT in the same period were 72.0% and 100%, respectively (P = 0.091). Multivariate analysis indicated that only Era I (relative risk = 2.606; P = 0.005) and pretransplant HCC (relative risk = 2.729; P = 0.002) adversely affected overall survival.
Conclusions: High midterm survivals were achieved by reduction of hospital mortality through accumulation of experience and transplanting recipients with low chance of recurrence of HCC. RLDLT could be considered as a legitimate alternative to DDLT.
Living donor liver transplantation (LDLT) is an alternative to deceased donor liver transplantation (DDLT) in the face of refractory shortage of deceased donor organs. A decade has passed, and LDLT remains characterized by its technical complexity and ethical controversies, which are interrelated. These all boil down to the fact that a single liver is shared between 2 subjects. For the recipient, LDLT is an effective means to survive; for the donor, it is a very major surgical operation, only for the benefit of another human subject. Besides the not fully known long-term consequences of the donor operation, there is an up to 20% donor morbidity and 0.5% donor mortality. Although the immediate survival benefits on the recipient in the high-urgency situation and elective situation are clear, an accurate definition of recipient midterm survival is lacking. Only with this knowledge, the risk (donor) benefit (recipient) ratio could come to light.
DDLTs with a track record of 4 decades were reported in large series. Mid- and long-term survivals and factors adversely affecting it, such as hepatitis C and hepatocellular carcinoma (HCC), were identified. Such data is not available for LDLT, which has a shorter history and smaller case numbers. This study analyzed a single center's experience over a decade on right liver LDLT (RLDLT) from the very first case.
Abstract and Introduction
Abstract
Summary Background Data: To define the donor risk and recipient benefit ratio, midterm outcome of this life-saving treatment modality ought to be known.
Methods: Consecutive patients from 9 May 1996 were included. Era I comprised the first 50 patients and Era II comprised the remaining 184 patients. Their midterm outcomes were compared with patients receiving deceased donor liver transplantation (DDLT) of the same period in the same center.
Results: With a median follow-up of 48 months, the 1-, 3-, and 5-year overall survival rates were 93.2%, 85.7%, and 82.4%, respectively and were comparable with those of DDLT (n = 131) (90.1%, 87.7%, and 85.2%) (P = 0.876). Hospital mortality decreased from 16% in Era I to 2.2% in Era II (P = 0.000). Reduced hospital mortality improved the overall survival rates from Era I to Era II (78%, 74%, and 72% vs. 97.3%, 88.7%, and 85.1%, respectively) (P = 0.003). The 5-year survival rate of recipients with hepatocellular carcinoma (HCC) (n = 65) was 65.7%. Starting from Era II, excellent 5-year survival of recipients without HCC was achieved as compared with DDLT in the same period (93.4% vs. 88.2%) (P = 0.493). The 5-year survival rates of recipients with HCC within the Milan criteria of Era II and DDLT in the same period were 72.0% and 100%, respectively (P = 0.091). Multivariate analysis indicated that only Era I (relative risk = 2.606; P = 0.005) and pretransplant HCC (relative risk = 2.729; P = 0.002) adversely affected overall survival.
Conclusions: High midterm survivals were achieved by reduction of hospital mortality through accumulation of experience and transplanting recipients with low chance of recurrence of HCC. RLDLT could be considered as a legitimate alternative to DDLT.
Introduction
Living donor liver transplantation (LDLT) is an alternative to deceased donor liver transplantation (DDLT) in the face of refractory shortage of deceased donor organs. A decade has passed, and LDLT remains characterized by its technical complexity and ethical controversies, which are interrelated. These all boil down to the fact that a single liver is shared between 2 subjects. For the recipient, LDLT is an effective means to survive; for the donor, it is a very major surgical operation, only for the benefit of another human subject. Besides the not fully known long-term consequences of the donor operation, there is an up to 20% donor morbidity and 0.5% donor mortality. Although the immediate survival benefits on the recipient in the high-urgency situation and elective situation are clear, an accurate definition of recipient midterm survival is lacking. Only with this knowledge, the risk (donor) benefit (recipient) ratio could come to light.
DDLTs with a track record of 4 decades were reported in large series. Mid- and long-term survivals and factors adversely affecting it, such as hepatitis C and hepatocellular carcinoma (HCC), were identified. Such data is not available for LDLT, which has a shorter history and smaller case numbers. This study analyzed a single center's experience over a decade on right liver LDLT (RLDLT) from the very first case.
SHARE
