Significance of Proper Graft Selection in Adult Living-Donor Liver Transplant Recipients with Preoperative Deteriorated Condition
Taku Iida, Koji Masuda, Takehisa Matsuyama, Shumpei Harada, Tsukasa Nakamura, Katsuhiro Koshino, Tomoyuki Suzuki, Shuji Nobori, Hidetaka Ushogome, Takashi Ito, Seisuke Sakamoto, Kenji Uryuhara, Hideaki Okajima, Satoshi Kaihara, Shinji Uemoto, Norio Yoshimura
Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto City, Kyoto, Japan
Ann Transplant 2017; 22:541-549
The outcome of living-donor liver transplantation (LDLT) is poor for recipients with severely deteriorated preoperative condition. This study therefore evaluated the proper graft selection according to the recipients’ preoperative condition.
MATERIAL AND METHODS: We evaluated the clinical outcomes in 66 patients who underwent adult LDLT from October 2003 to June 2016 in our institution, excluding fulminant liver failure and ABO-incompatible cases. Preoperative risk factors included MELD score >20, preoperative hospitalization for over 2 weeks or intensive care unit admission and bacterial infection within 1 month before LDLT. Patients were classified into those with 0–1 risk factors (Group LR, n=44) and those with 2–3 risk factors (Group HR, n=22).
RESULTS: The overall survival (OS) rate after LDLT was significantly lower in Group HR than in Group LR (1-year: HR 83.9% vs. LR 93%, 3-year: HR 70.8% vs. LR 90.5%, 5-year: HR 62% vs. LR 87.6%; p=0.029). In Group LR, OS rates did not differ significantly by graft type or donor age. In Group HR, OS rates at 1 (93.8% vs. 66.7%), 3 (85.2% vs. 50%), and 5 (75.8% vs. 25%) years were significantly higher using right (n=16) vs. left (n=6) lobe grafts (p=0.046).
CONCLUSIONS: Proper graft selection is very important to improve the outcome of LDLT recipients in deteriorated preoperative condition. LDLT using right-lobe grafts may be recommended for high-risk severely deteriorated patients.
Keywords: Graft Survival, Liver Transplantation, Transplantation