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World Journal of Surgery

, Volume 27, Issue 3, pp 356–364 | Cite as

Analysis of Failure in Living Donor Liver Transplantation: Differential Outcomes in Children and Adults

  • Michael J. Goldstein
  • Ephrem Salame
  • Sandip Kapur
  • Milan Kinkhabwala
  • Diane LaPointe-Rudow
  • Patricia Harren
  • Steven J. Lobritto
  • Mark Russo
  • Robert S. Brown
  • Guellue Cataldegirmen
  • Alan Weinberg
  • John F. Renz
  • Jean C. Emond
Original Scientific Reports

Abstract

Over the past decade we have reported excellent outcomes in pediatric living-donor liver transplantation (LDLT) with recipient survival exceeding 90%. Principles established in these patients were extended to LDLT in adults. To compare outcomes in donors and recipients between adult and pediatric LDLT in a single center, we reviewed patient records of 45 LDLT performed between 1/98 and 2/01: 23 adult LDLT (54 ± 6.5 yr) and 22 pediatric LDLT (33.7 ± 53.5 months). Preoperative liver function was worse in adults (International Normalized Ratio [INR] 1.5 ± 0.4 vs. INR 1.2 ± 0.5; p = 0.032). 4 adults (17%) met criteria for status 1 or 2A. Only 1 child was transplanted urgently. Analysis included descriptive statistics and Kaplan-Meier estimation. Donor mortality was 0% with 1 re-exploration, 2.4%. Median hospital stay (LOS) was 6.0 days (range, 4–12 days). Donor morbidity and LOS did not differ by sex, extent of hepatectomy, or adult and pediatric LDLT (p = 0.49). In contrast, recipient outcomes were worse for adults. Adult 1 year graft survival was 65% (3 retransplants [ReTx], 5 deaths) vs. 91% for children (1 ReTx, 1 death) p = 0.02. Graft losses in adults were due to sepsis (n = 3), small for size (n = 2), suicide, and hepatic artery thrombosis (HAT), whereas in children graft losses were due to portal thrombosis and total parenteral nutrition (TPN) liver failure. Biliary leaks occurred in 22% of adults and 9% of children. Hepatic vein obstruction occurred in 17% of adults and in none of the children. Median LOS was comparable (adult, 16.5 days (range, 7–149 days); child, 17 days (range, 10–56 days), p = 0.2). Graft function (total bilirubin (TBili) < 5mg/dl, INR < 1.2, aspartate aminotransferase (AST) < 100 U/l) normalizing by day 4 in children and by day 14 in adults. Adults fared worse, with an array of problems not seen in children, in particular, hepatic vein obstruction and small-for-size syndrome. Biliary leaks were diagnosed later in adults and were lethal in 3 cases; this was later avoided with biliary drainage in adult recipients. Finally, use of LDLT in decompensated adults led to death in 3 of 4 patients, and should be restricted to elective use.

Keywords

International Normalize Ratio Live Donor Liver Transplantation Graft Loss Donor Liver Transplantation Live Donor Liver 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirurgie 2003

Authors and Affiliations

  • Michael J. Goldstein
    • 1
  • Ephrem Salame
    • 2
  • Sandip Kapur
    • 1
  • Milan Kinkhabwala
    • 1
  • Diane LaPointe-Rudow
    • 1
  • Patricia Harren
    • 1
  • Steven J. Lobritto
    • 1
  • Mark Russo
    • 1
  • Robert S. Brown
    • 1
  • Guellue Cataldegirmen
    • 1
  • Alan Weinberg
    • 1
  • John F. Renz
    • 3
  • Jean C. Emond
    • 1
  1. 1.Liver Center, New York Presbyterian Hospital, 622 W. 168th Street, PH14C, 10032, New York, New York, USA
  2. 2.Service de Chirurgie Digestive, CHU Côte de Nacre, 14000, Caen, France
  3. 3., Dumont-UCLA Transplant Center, 10833 Le Conte Avenue, 90095, Los Angeles, California, USA

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