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Improved Survival After Live Donor Adult Liver Transplantation (LDALT) Using Right Lobe Grafts: Program Experience and Lessons Learned
Authors:J.J. Pomposelli   J. Verbesey  M.A. Simpson  W.D. Lewis  F.D. Gordon  U. Khettry  C. Wald  S. Ata  D. Morin  K. Garrigan  R.L. Jenkins   E.A. Pomfret
Affiliation:Division of Hepatobiliary Surgery and Liver Transplantation, Lahey Clinic Medical Center, Burlington, MA 01805, USA. james.j.pomposelli@lahey.org
Abstract:We present our program experience with 85 live donor adult liver transplantation (LDALT) procedures using right lobe grafts with five simultaneous live donor kidney transplants using different donors performed over a 6-year period. After an "early" 2-year experience of 25 LDALT procedures, program improvements in donor and recipient selection, preoperative imaging, donor and recipient surgical technique and immunosuppressive management significantly reduced operative mortality (16% vs. 3.3%, p = 0.038) and improved patient and graft 1-year survival in recipients during our "later" experience with the next 60 cases (January 2001 and March 2005; patient survival: early 70.8% vs. later 92.7%, p = 0.028; graft survival: Early 64% vs. later 91.1%, p = 0.019, respectively). Overall patient and graft survival were 82% and 80%. There was a trend for less postoperative complications (major and minor) with program experience (early 88% vs. later 66.7%; p = 0.054) but overall morbidity remained at 73.8%. Biliary complications (cholangitis, disruption, leak or stricture) were not influenced by program experience (early 32% vs. later 38%). Liver volume adjusted to 100% of standard liver volume (SLV) within 1 month post-transplant. Despite a high rate of morbidity after LDALT, excellent patient and graft survival can be achieved with program experience.
Keywords:Complications    graft survival    live donor    liver transplantation    outcome    patient survival
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