Right-liver living donor transplantation for decompensated end-stage liver disease |
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| Institution: | 1. Department of Biomedicine, University of Basel, Switzerland;2. University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland;3. Laboratory of Hepatology, Department of Chronic Diseases, Metabolism and aging (CHROMETA), University of Leuven, Leuven, Belgium;4. Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, Leuven, Belgium;5. INSERM U1149, Centre de Recherche sur l''Inflammation, Paris, France;6. UMRS1149, Université Paris Diderot-Paris 7, Paris, France;7. Centre National de la Recherche Scientifique (CNRS), Paris, France;1. Translational Hepatology, Internal Medicine I, Goethe University Frankfurt, Germany;2. European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain;3. Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark;4. Institute for Liver and Digestive Health, Royal Free Campus, University College London, United Kingdom;5. Department of Medicine, University of California San Diego, La Jolla, CA, USA;6. Department of Medicine, VA San Diego Healthcare System, San Diego, CA, USA;7. Institute of Liver Studies, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, Denmark Hill Campus, London, United Kingdom;8. Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, VA, USA;1. Division of Hepatology, Baylor University Medical Center, Dallas, Texas;3. Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota;1. Liver Intensive Therapy Unit, King''s College Hospital, London, UK;2. Histopathology Section, Institute of Liver Studies, King''s College Hospital, London, UK;3. Liver Failure Group, Division of Medicine, University College London, London, UK;4. Institute for Liver and Digestive Health, Division of Medicine, University College London, London, UK;5. Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK;6. Department of Hepatology, University of Edinburgh, Edinburgh, UK |
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| Abstract: | Adult-to-adult living donor liver transplantation (LDLT) for patients with decompensated end-stage liver disease (DELD) is controversial. Nevertheless, these patients are most in need of a timely liver transplant. We present the results of 7 patients who underwent transplantation with this procedure and discuss the rationale for its possible broader application. Seven of 51 patients who underwent right LDLT (segments 5 to 8) between August 1998 and April 2001 had DELD, defined as Child-Pugh-Turcotte score greater than 13 or Model for End-Stage Liver Disease score greater than 30. All patients also were listed for cadaveric liver transplantation. Mean age of the 7 transplant recipients was 54 years (range, 44 to 63 years). Three patients had ethyltoxic cirrhosis; 2 patients, hepatitis C; 1 patient, hepatitis B; and 1 patient, autoimmune hepatitis cirrhosis. The average intensive care unit stay was 23 days (range, 3 to 88 days), and average hospital stay was 77 days (range, 27 to 132 days). Three patients are alive 31, 21, and 17 months after LDLT. At a mean follow-up of 15.1 ± 10 months, patient and graft survival rates are 43%. Four transplant recipients died day 30, 60, 117, and 180 after transplantation. Three of the seven donors (43%) experienced a complication. At present, all donors are well and have returned to their normal activities. No donors had regrets about the procedure, and all donors stated that they would donate again if presented with the same decision. In conclusion, with the lack of other therapeutic options, LDLT represents a timely and effective alternative to cadaveric liver transplantation. Better outcome is foreseeable with a decrease in posttransplantation complications and more experience in predicting survival of these critical patients. (Liver Transpl 2002;8:340-346.) |
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