2. Factors Associated With Graft Failure and Outcome In 354 Adult Living Donor Liver Transplants (ALDLT): A Report From the A2ALL Consortium
Kim M. Olthoff, MD*1, Michael M. Abecassis, MD*2, Jeffrey Fair, MD*3, Robert A. Fisher, MD*4, Chris E. Freise, MD*5, Rafik M. Ghobrial, MD, PhD*6, Igal Kam, MD*7, Robert M. Merion, MD*8, Timothy L. Pruett, MD9, Jean C. Emond, MD10
1University of Pennsylvania, Philadelphia, PA; 2Northwestern University, Chicago, IL; 3University of North Carolina, Chapel Hill, NC; 4Virginia Commonwealth University, Richmond, VA; 5University of California, San Francisco, San Francisco, CA; 6University of California, Los Angeles, Los Angeles, CA; 7University of Colorado, Denver, CO; 8University of Michigan, Ann Arbor, MI; 9University of Virginia, Charlottesville, VA; 10Columbia Presbyterian Medical Center, New York, NY
OBJECTIVE(S): ALDLT remains a controversial alternative to standard OLT. A2ALL, a consortium committed to structured analysis of ALDLT, herein presents the first multicenter report characterizing variables predictive of graft failure.
METHODS: 354 ALDLT recipients transplanted at 9 centers between 4/98 and 8/03 were studied. . Cox models adjusted for age were used to examine the relationship between each of 35 donor, recipient, intraoperative and postoperative variables and the risk of graft failure.
RESULTS: Median follow-up was 2.2 years. Unadjusted graft survival was 87.6% and 82.6% at 90 days and 1-year respectively. 44 graft failures occurred in the first 90 days (18 deaths, 26 retransplants). Graft loss was most commonly caused by vascular thrombosis (16), primary nonfunction (9), recurrent hepatitis (6) and sepsis (5). Overall, 7.3% experienced vascular complications and 21% required reoperation. Older recipient age was associated with higher risk of graft failure (RR=1.04 per year, p<0.0001). Increased center experience was associated with a 45% lower risk of graft failure (p=0.01). Need for dialysis and operative blood loss were significantly associated with graft failure (p<0.02). Graft to recipient weight ratio did not gain significance. Biliary complications were common (30%), but did not contribute to failure.
CONCLUSIONS: This multicenter experience provides strong evidence that ALDLT is a viable option for liver replacement with outcomes which improve with experience. Older age and recipient condition, but not graft size, increased the risk of graft failure. As technical failures decrease, the benefits of ALDLT will further accrue.