Complications and mortality after adult to adult living donor liver transplantation: A retrospective cohort study

Emad Hamdy Gad, Ayman Alsebaey, Maha Lotfy, Mohamed Eltabbakh, Ahmed Alshawadfy Sherif, Emad Hamdy Gad, Ayman Alsebaey, Maha Lotfy, Mohamed Eltabbakh, Ahmed Alshawadfy Sherif

Abstract

Background and aims: Living donor liver transplantation (LDLT) is widely performed for patients to resolve the critical shortage of organs from cadavers. Despite rapid implementation of the procedure, both complications and mortality of LDLT are annoying problems. The aim of this study was to analyze complications and mortality of patients after adult to adult LDLT (A-ALDLT) in a single center.

Methods: Between April 2003 and November 2013, 167 (A-ALDLT) recipients in National Liver Institute, Egypt were included. We retrospectively analyzed complications and mortality in them.

Results: The overall incidence of complications was 86.2% (n = 144) and classified as biliary 43.7% (n = 73), vascular 21.6% (n = 36), Small for size syndrome (SFSS) 12.6% (n = 21), Gastrointestinal tract (GIT) 19.8% (n = 33), wound 12.6% (n = 21), chest 19.8% (n = 33), neurological 26.3% (n = 44), renal 21% (n = 35), intra abdominal collection 21.6% (n = 36), recurrent hepatitis C virus (HCV) 16.8% (n = 28), recurrent hepatocellular carcinoma (HCC) 2.4% (n = 4), acute rejection 19.2% (n = 32). 65 (45.1%) of 144 complicated patients died, while 10 (43.5%) of 23 non complicated died. The incidence of whole, in hospital and late mortalities were 44.9%, 28.7% and 16.2% respectively.

Conclusions: Mortality was higher among complicated cases where vascular complications and SFSS had significant effect on it so prevention and treatment of them is required for improving outcome.

Keywords: Complications after LDLT; Living donor liver transplantation (LDLT); Mortality after LDLT; Outcome post LDLT.

Figures

Fig. 1
Fig. 1
A-a case with 3 “duct to duct” biliary anastamoses” B- Tube cholangiogram showing a case with anastomotic biliary leak. C- Magnetic resonance cholangio pancreatography (MRCP) shows a case with anastamotic stricture. D- ERCP shows anastomotic biliary stricture.
Fig. 2
Fig. 2
A- Identification of 2 graft bile ducts in case of biliary stricture after LDLTx, B- The same patient underwent biliary enteric anastamosis on the 2 graft bile ducts. C- Tube cholangiogram after HJ with good biliary drainage.
Fig. 3
Fig. 3
A- A patient with HAT and aneurysm. B- The patient underwent coiling of aneurysm and stenting of HAT.
Fig. 4
Fig. 4
A patient with HAT and multiple hepatic abscesses managed with stenting of HAT and pigtail and antibiotics for abscesses.
Fig. 5
Fig. 5
(A)- Picture of a native liver of HCC patient (1 FL, 3.5 cm, within Milan), (B)- The picture of the graft after implantation to the patient. (C)- Triphasic CT abdomen of the previous patient, with HCC recurrence, in the form of hepatic recurrence, 35 months, post transplantation, he underwent surgical exploration.
Fig. 6
Fig. 6
Kaplan–Meier survival curves. A: KM survival curve. B: VC and survival (Log rank = 0.01). C: SFSS and survival (Log rank = 0.00).

References

    1. Boraschi P., Donati F. Complications of orthotopic liver transplantation: imaging findings. Abdomen Imaging. 2004;29(2):189–202.
    1. Saner F., Gu Y., Minouchehr S. Neurological complications after cadaveric and living donor liver transplantation. J Neurol. 2006;253:612–617.
    1. Chok K.S.H., Chan S.C., Fung J.Y.Y. Survival outcomes of right-lobe living donor liver transplantation for patients with high model for end-stage liver disease scores. Hepatobiliary Pancreat Dis Int. 2013;12:256–262.
    1. Shin M., Moon H.H., Kim J.M. Importance of donor-recipient age gradient to the prediction of graft outcome after living donor liver transplantation. Transplant Proc. 2013;45:3005–3012.
    1. Du Z.G., Wei Y.G., Chen K. Risk factors and criteria predicting early graft loss after adult-to-adult living donor liver transplantation. J Surg Res. 2014;187:673–682.
    1. Radtke A., Sgourakis G., Sotiropoulos G.C. Vascular and biliary anatomy of the right hilar window: its impact on recipient morbidity and mortality for right graft live donor liver transplantation. World J Surg. 2009;33:1941–1951.
    1. Abdelaziz O., Abdel Samie A., Metwally L.I.A. Multi-slice computed tomography imaging of the post transplant complications in the recipients after living donor liver transplantation. Egypt J Radiology Nucl Med. 2013;44:697–704.
    1. Zamboni G.A., Pedrosa I., Kruskal J.B. Multimodality postoperative imaging of liver transplantation. Eur Radiol. 2008;18:882–889.
    1. Johnston S.D., Morris J.K., Cramb R. Cardiovascular morbidity and mortality after orthotopic liver transplantation. Transplantation. 2002;73:901–906.
    1. Thuluvath P.J. Evaluation of liver transplant recipients. J Clin Exp Hepatol. 2011;1:199–203.
    1. Bogin V., Tan H.P., Marcos A. Living-donor liver transplantation. evaluation: specific issues. In: Tan H.P., Marcos A., Shapiro R., editors. Living donor transplantation. lnforma Healthcare USA, Inc.; New York, NY: 2007. pp. 159–168.
    1. Chuan L., Tian-Fu W., Lu-Nan Y. Predictors of patient survival following living donor liver transplantation. Hepatobiliary Pancreat Dis Int. 2011;10:248–253.
    1. Ryuichi Y., Takayuki I., Takahito Y. Preoperative assessment of the risk factors that help to predict the prognosis after living donor liver transplantation. World J Surg. 2008;32:2419–2424.
    1. Goldstein M.J., Salame E., Kapur S. Analysis of failure in living donor liver transplantation: differential outcomes in children and adults. World J Surg. 2003;27:356–364.
    1. Ikegami T., Shirabe K., Yoshiya S. Bacterial sepsis after living donor liver transplantation: the impact of early enteral nutrition. J Am Coll Surg. 2012;214:288–295.
    1. Kim B.S., Lee S.G., Hwang S. Influence of pre-transplantation bacterial and fungal culture positivity on outcome after living donor liver transplantation. Transplant Proc. 2009;41:250–252.
    1. Fagiuoli S., Colli A., Bruno R. Management of infections pre- and post-liver transplantation: report of an AISF consensus conference. J Hepatol. 2014;60:1075–1089.
    1. Fortun J., Martin-Davila P., Montejo M. Prophylaxis with caspofungin for invasive fungal infections in high-risk liver transplant recipients. Transplantation. 2009;87:424–435.
    1. Sun H.Y., Cacciarelli T.V., Singh N. Micafungin vs. amphotericin B lipid complex for the prevention of invasive fungal infections in high-risk liver transplant recipients. Transplantation. 2013;96:573–578.
    1. Aguado J.M., Varo E., Usetti P. Safety of anidulafungin in solid organ transplant recipients. Liver Transpl. 2012;18:680–685.
    1. Paya C., Humar A., Dominguez E. Efficacy and safety of valganciclovir vs. oral ganciclovir for prevention of cytomegalovirus disease in solid organ transplant recipients. Am J Transpl. 2004;4:611–620.
    1. Francoz C., Valla D., Durand F. Portal vein thrombosis, cirrhosis, and liver transplantation. J Hepatol. 2012;57:203–212.
    1. Taniai N., Onda M., Tajiri T. Anticoagulant therapy in living-related liver transplantation. Transplant Proc. 2002;34:2788–2790.
    1. Kaneko J., Sugawara Y., Tamura S. Heparin-induced thrombocytopenia after liver transplantation. Transplant Proc. 2014;40:1518–1521.
    1. Dindo D., Demartines N., Clavien P.A. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213.
    1. Clavien P.A., Camargo C.A., Croxford R., Langer B., Levy G.A., Greig P.D. Definition and classification of negative outcomes in solid organ transplantation. Application in liver transplantation. Ann Surg. 1994;220:109–120.
    1. Lin C.C., Chuang F.R., Wang C.C. Early postoperative complications in recipients of living donor liver transplantation. Transplant Proc. 2004;36:2338–2341.
    1. Ho M.C., Wu Y.M., Hu R.H. Surgical complications and outcome of living related liver transplantation. Transplant Proc. 2004;36:2249–2251.
    1. Tsui T.Y., Scherer M.N., Schnitzbauer A.A. Adult living donor liver transplantation: body mass index and MELD score of recipients are independent risk factors for hospital mortality. Langenbecks Arch Surg. 2009;394:235–241.
    1. Marsh J.W., Gray E., Ness R. Complications of right lobe living donor liver transplantation. J Hepatol. 2009;51:715–724.
    1. Väli T., Tein A., Tikk T. Surgical complications accompanying liver transplantation in estonia. Transplant Proc. 2010;42:4455–4456.
    1. Lee K.W., Joh J.W., Kim S.J. High hilar dissection: new technique to reduce biliary complication in living donor liver transplantation. Liver Transpl. 2004;10:1158–1162.
    1. Duailibi D.F., Ribeiro M.A. Biliary complications following deceased and living donor liver transplantation: a review. Transpl Proc. 2010;42:517–520.
    1. Hashimoto K., Miller C.M., Quintini C. Is impaired hepatic arterial buffer response a risk factor for biliary anastomotic stricture in liver transplant recipients? Surgery. 2010;148:582–588.
    1. Kumar A., Wadhawan M., Taneja S. Biliary complications after liver transplantation. Apollo Med. 2012;9:32–37.
    1. Jung S.W., Kim D.S., Yu Y.D. Clinical outcome of internal stent for biliary anastomosis in liver transplantation. Transplant Proc. 2014;46:856–860.
    1. Duffy J.P., Hong J.C., Farmer D.G. Vascular complications of orthotopic liver transplantation: experience in more than 4,200 patients. J Am Coll Surg. 2009;208:896–905.
    1. Steinbrück K., Enne M., Fernandes R. Vascular complications after living donor liver transplantation: a brazilian, single-center experience. Transplant Proc. 2011;43:196–198.
    1. Khalaf H. Vascular complications after deceased and living donor liver transplantation: a single-center experience. Transplant Proc. 2010;42:865–870.
    1. Yagi S., Uemoto S. Small-for-size syndrome in living donor liver transplantation. Hepatobiliary Pancreat Dis Int. 2012;11:570–576.
    1. Rajekar H. Small-for-size syndrome in adult liver transplantation: a review. Indian J Transplant. 2013;7:53–58.
    1. Lee H.H., Joh J.W., Lee K.W. Small-for-size graft in adult living-donor liver transplantation. Transplant Proc. 2004;36:2274–2276.
    1. Kiuchi T., Onishi Y., Nakamura T. Small-for-size graft: not defined solely by being small for size. Liver Transpl. 2010;16:815–817.
    1. Kuramitsu K., Fukumoto T., Iwasaki T. Long-term complications after liver transplantation. Transplant Proc. 2014;46:797–803.
    1. Akamatsu N., Sugawara Y., Tamura S. Renal impairment after living donor liver transplantation. Transplant Proc. 2006;38:1474–1476.
    1. Iwata H., Mizuno S., Ishikawa E. Negative prognostic impact of renal replacement therapy in adult living-donor liver transplant recipients: preoperative recipient condition and donor factors. Transplant Proc. 2014;46:716–720.
    1. Beltran M.M., Marugan R.B., Oton E. Accuracy of magnetic resonance cholangiography in the evaluation of late biliary complications after orthotopic liver transplantation. Transpl Proc. 2005;37:3924–3925.
    1. Escartin A., Sapisochin G., Bilbao I. Recurrence of hepatocellular carcinoma after liver transplantation. Transpl Proc. 2007;39(7):2308–2310.
    1. Kurtovic J., Riordan S.M., Williams R. Liver transplantation for hepatocellular carcinoma. Best Pract Res Clin Gastroenterol. 2005;19:147–160.
    1. Yosry A., Esmat G., El-Serafy M. Outcome of living donor liver transplantation for Egyptian patients with hepatitis C (genotype 4) related cirrhosis. Transplant Proc. 2008;40:1481–1484.
    1. Lewis M.B., Howdle P.D. Neurologic complications of liver transplantation in adults. Neurology. 2003;61:1174–1178.
    1. Stracciari A., Guarino M. Neuropsychiatric complications of liver transplantation. Metab Brain Dis. 2001;16:3–11.
    1. Saner F.H., Gensicke J., Damink S.W. Neurologic complications in adult living donor liver transplant patients: an underestimated factor? J Neurol. 2010;257:253–258.
    1. Wang W.L., Yang Z.F., Lo C.M. Intracerebral hemorrhage after liver transplantation. Liver Transpl. 2000;6:345–348.
    1. Xiao L., Fu Z.R., Ding G.S. Prediction of survival after liver transplantation for chronic severe hepatitis B based on preoperative prognostic scores: a single center's experience in china. World J Surg. 2009;33:2420–2426.
    1. Stey A.M., Doucette J., Florman S. Donor and recipient factors predicting time to graft failure following orthotopic liver transplantation: a transplant risk index. Transplant Proc. 2013;45:2077–2082.
    1. Toshima T., Ikegami T., Kimura K. Application of postoperative model for end-stage liver disease scoring system for evaluating liver graft function after living donor liver transplantation. Transplant Proc. 2014;46:81–86.
    1. Jo Y.Y., Choi Y.S., Joo D.J. Pretransplant mortality predictors in living and deceased donor liver transplantation. J Chin Med Assoc. 2014;77:16–20.
    1. Chung H.S., Jung D.H., Park C.S. Intraoperative predictors of short-term mortality in living donor liver transplantation due to acute liver failure. Transplant Proc. 2013;45:236–240.
    1. Kaido T., Mori A., Ogura Y. Pre- and perioperative factors affecting infection after living donor liver transplantation. Nutrition. 2012;28:1104–1108.
    1. Hoek B.V., Rooij B.J., Verspaget H.W. Risk factors for infection after liver transplantation. Best Pract Res Clin Gastroenterol. 2012;26:61–72.
    1. Sganga G., Bianco G., Fiori B. Surveillance of bacterial and fungal infections in the postoperative period following liver transplantation: a series from 2005–2011. Transplant Proc. 2013;45:2718–2721.
    1. Seoul Kim S.I., Kim Y.J., Jun Y.H. Epidemiology and risk factors for bacteremia in 144 consecutive living-donor liver transplant recipients. Yonsei Med J. 2009;50:112–121.
    1. Essen Saner F.H., Olde Damink S.W., Pavlakovic G. Pulmonary and blood stream infections in adult living donor and cadaveric liver transplant patients. Transplantation. 2008;85:1564–1568.
    1. Douthitt L., Bezinover D., Uemura T. Perioperative use of continuous renal replacement therapy for orthotopic liver transplantation. Transplant Proc. 2012;44:1314–1317.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe