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 23 February 2018

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Liver replacement viable with living donor liver transplant

Adult living donor liver transplantation is a viable option for liver replacement, reports September's Annals of Surgery with evidence that older recipient age and prolonged cold ischemia time increase the risk of graft failure.

News image

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Previous reports regarding adult living donor liver transplants have been center-specific or from large databases lacking detailed variables.

The Adult-to-Adult Living Donor Liver Transplantation Cohort Study represents the first detailed North American multicenter report of recipient risk.

This study aims to characterize variables predictive of graft failure.

Dr Kim Olthoff and colleagues characterized the patient population with respect to patient selection.

The research team also assessed surgical morbidity and graft failures.

In addition, the team analyzed the contribution of perioperative clinical factors to recipient outcome in adult living donor liver transplantation.

The researchers studied 385 adult living donor liver transplantation recipients from 9 centers.

The team analyzed over 35 donor, recipient, intraoperative, and postoperative variables.

1-year graft survival was 81%
Annals of Surgery

Cox regression models were used to examine the relationship of variables to the risk of graft failure.

The researchers found that 90-day and 1-year graft survival were 87% and 81%, respectively.

The research team observed that 13% of grafts failed in the first 90 days.

The most common causes of graft failure were vascular thrombosis, primary nonfunction, and sepsis.

Biliary complications were common, and the team noted that 30% occurred early, and 11% at a late stage.

The researchers found that older recipient age and length of cold ischemia were significant predictors of graft failure.

Center experience greater than 20 adult living donor liver transplantations was associated with a significantly lower risk of graft failure.

The team noted that recipient Model for End-stage Liver Disease score and graft size were not significant predictors.

Dr Olthoff's team concluded, “This multicenter Adult-to-Adult Living Donor Liver Transplantation Cohort Study experience provides evidence that adult living donor liver transplantation is a viable option for liver replacement.”

“Older recipient age and prolonged cold ischemia time increase the risk of graft failure.”

“Outcomes improve with increasing center experience.”

Ann Surg 2005: 242(3): 314-25
06 September 2005

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