Topic: E. Clinical Pediatric Surgery/Transplantation/Endocrine/Plastics Surgery
A Decade of Right Liver Adult-to-Adult Living Donor Liver Transplantation - the Recipients Mid-term Outcomes
See C Chan, Barbara H Chik, Chi L Liu, Chung M Lo, Sheung T Fan, John Wong
University of Hong Kong Medical Center, Hong Kong, Hong Kong
We analyzed a single center’s experience over a decade of right liver living donor liver transplantation (LDLT).
Consecutive patients from 9 May 1996 were included. Era I comprised the first 50 patients and Era II the remaining 184. Deceased donor liver transplantation (DDLT) outcomes of the same period in the same center were used for comparison.
With a median follow-up of 48 months, the 1-, 3-, and 5-year overall survivals were 93.2%, 85.7%, and 82.4% and were comparable to DDLT (n=131) of the same period (89.3%, 86.6%, and 83.5%) (p=0.876). The hospital mortality decreased from 16% in Era I to 2.2% in Era II (p = 0.000). Reduced hospital mortality improved survivals from Era I to II (78%, 74%, and 72% versus 97.3%, 88.7%, and 85.1%, respectively) (p=0.003). The 5-year survival of recipients with HCC within the Milan criteria (n=42) was 69.6%. Multivariate analysis indicated that only Era I (RR=2.606, p=0.005) and pre-transplant HCC (RR=2.729, p=0.002) adversely affecting overall survival and disregard emergent LDLT and recipient Model-for-End-stage Liver Disease scores.
Starting from Era II, excellent 5-year survival of recipients without HCC was achieved as compared with DDLT in the same period (93.4% versus 88.2%) (p=0.493). The 5-year survival rates of recipients with HCC within the Milan criteria for Era II and DDLT in the same period were 72.0% and 100%, respectively (p=0.091).
High mid-term survivals are achieved by reduction of hospital mortality through accumulation of experience and transplanting recipients with low chance of recurrence of HCC.