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Anouti A, Al Hariri M, VanWagner LB, Lee WM, Mufti A, Pedersen M, Shah J, Hanish S, Vagefi PA, Cotter TG, Patel MS. Early Graft Failure After Living-Donor Liver Transplant. Dig Dis Sci 2024; 69:1488-1495. [PMID: 38381224 DOI: 10.1007/s10620-024-08280-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/04/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Living-donor liver transplantation (LDLT) has been increasing in the USA. While data exist on longer-term patient and graft outcomes, a contemporary analysis of short-term outcomes is needed. AIM Evaluate short-term (30-day) graft failure rates and identify predictors associated with these outcomes. METHODS Adult (≥ 18) LDLT recipients from 01/2004 to 12/2021 were analyzed from the United States Scientific Registry of Transplant Recipients. Graft status at 30 days was assessed with graft failure defined as retransplantation or death. Comparison of continuous and categorical variables was performed and a multivariable logistic regression was used to identify risk factors of early graft failure. RESULTS During the study period, 4544 LDLTs were performed with a graft failure rate of 3.4% (155) at 30 days. Grafts from male donors (aOR: 0.63, CI 0.44-0.89), right lobe grafts (aOR: 0.40, CI 0.27-0.61), recipients aged > 60 years (aOR: 0.52, CI 0.32-0.86), and higher recipient albumin (aOR: 0.73, CI 0.57-0.93) were associated with superior early graft outcomes, whereas Asian recipient race (vs. White; aOR: 3.75, CI 1.98-7.10) and a history of recipient PVT (aOR: 2.7, CI 1.52-4.78) were associated with inferior outcomes. LDLTs performed during the most recent 2016-2021 period (compared to 2004-2009 and 2010-2015) resulted in significantly superior outcomes (aOR: 0.45, p < 0.001). CONCLUSION Our study demonstrates that while short-term adult LDLT graft failure is uncommon, there are opportunities for optimizing outcomes by prioritizing right lobe donation, improving candidate nutritional status, and careful pre-transplant risk assessment of candidates with known PVT. Notably, a period effect exists whereby increased LDLT experience in the most recent era correlated with improved outcomes.
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Affiliation(s)
- Ahmad Anouti
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Lisa B VanWagner
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - William M Lee
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - Arjmand Mufti
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mark Pedersen
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jigesh Shah
- Department of Surgery, UT Southwestern Medical Center, 5959 Harry Hines Blvd, HP04.102, Dallas, TX, 75390, USA
| | - Steven Hanish
- Department of Surgery, UT Southwestern Medical Center, 5959 Harry Hines Blvd, HP04.102, Dallas, TX, 75390, USA
| | - Parsia A Vagefi
- Department of Surgery, UT Southwestern Medical Center, 5959 Harry Hines Blvd, HP04.102, Dallas, TX, 75390, USA
| | - Thomas G Cotter
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - Madhukar S Patel
- Department of Surgery, UT Southwestern Medical Center, 5959 Harry Hines Blvd, HP04.102, Dallas, TX, 75390, USA.
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2
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Tulla KA, Tinney FJ, Cameron AM. Outcomes of Living Donor Liver Transplantation Compared with Deceased Donor Liver Transplantation. Surg Clin North Am 2024; 104:79-88. [PMID: 37953042 DOI: 10.1016/j.suc.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Improved surgical techniques and revolutionary immunosuppressive agents have enhanced the long-term outcomes for liver transplantation, with more patients seeking the benefits of liver transplantation, and demand is high. In this review, we hope to delineate where the current data supporting favorable outcomes in using live donation to expand the donor pool compared with the outcomes seen in deceased donor liver transplants. Advances in surgery, transplant and center comfort has made live donor transplantation an asset with favorable patient outcomes in comparison to decease donor data.
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Affiliation(s)
- Kiara A Tulla
- Department of Surgery, Division of Transplant Surgery, John Hopkins Medicine
| | - Francis J Tinney
- Department of Surgery, Division of Transplant Surgery, John Hopkins Medicine
| | - Andrew M Cameron
- Department of Surgery, Johns Hopkins University School of Medicine, John Hopkins Medicine, 720 Rutland Avenue, Ross 765, Baltimore, MD 21205, USA.
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3
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Fujiki M, Pita A, Kusakabe J, Sasaki K, You T, Tuul M, Aucejo FN, Quintini C, Eghtesad B, Pinna A, Miller C, Hashimoto K, Kwon CHD. Left Lobe First With Purely Laparoscopic Approach: A Novel Strategy to Maximize Donor Safety in Adult Living Donor Liver Transplantation. Ann Surg 2023; 278:479-488. [PMID: 37436876 DOI: 10.1097/sla.0000000000005988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Evaluate outcome of left-lobe graft (LLG) first combined with purely laparoscopic donor hemihepatectomy (PLDH) as a strategy to minimize donor risk. BACKGROUND An LLG first approach and a PLDH are 2 methods used to reduce surgical stress for donors in adult living donor liver transplantation (LDLT). But the risk associated with application LLG first combined with PLDH is not known. METHODS From 2012 to 2023, 186 adult LDLTs were performed with hemiliver grafts, procured by open surgery in 95 and PLDH in 91 cases. LLGs were considered first when graft-to-recipient weight ratio ≥0.6%. Following a 4-month adoption process, all donor hepatectomies, since December 2019, were performed laparoscopically. RESULTS There was one intraoperative conversion to open (1%). Mean operative times were similar in laparoscopic and open cases (366 vs 371 minutes). PLDH provided shorter hospital stays, lower blood loss, and lower peak aspartate aminotransferase. Peak bilirubin was lower in LLG donors compared with right-lobe graft donors (1.4 vs 2.4 mg/dL, P < 0.01), and PLDH further improved the bilirubin levels in LLG donors (1.2 vs 1.6 mg/dL, P < 0.01). PLDH also afforded a low rate of early complications (Clavien-Dindo grade ≥ II, 8% vs 22%, P = 0.007) and late complications, including incisional hernia (0% vs 13.7%, P < 0.001), compared with open cases. LLG was more likely to have a single duct than a right-lobe graft (89% vs 60%, P < 0.01). Importantly, with the aggressive use of LLG in 47% of adult LDLT, favorable graft survival was achieved without any differences between the type of graft and surgical approach. CONCLUSIONS The LLG first with PLDH approach minimizes surgical stress for donors in adult LDLT without compromising recipient outcomes. This strategy can lighten the burden for living donors, which could help expand the donor pool.
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Affiliation(s)
- Masato Fujiki
- Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Alejandro Pita
- Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Jiro Kusakabe
- Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Kazunari Sasaki
- Department of Surgery, Division of Abdominal Transplant, Stanford University, Palo Alto, CA
| | - Taesuk You
- Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Munkhbold Tuul
- Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Cristiano Quintini
- General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Bijan Eghtesad
- Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Antonio Pinna
- Transplant Center, Cleveland Clinic Florida, Weston, FL
| | - Charles Miller
- Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Koji Hashimoto
- Department of General Surgery, Cleveland Clinic, Cleveland, OH
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4
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Fujiki M, Hashimoto K, Aucejo F, David Kwon CH, Eghtesad B, Miller C, Pinna A. Response to Comment on "Living Donor Liver Transplantation With Augmented Venous Outflow and Splenectomy: A Promised Land for Small Left Lobe Grafts". ANNALS OF SURGERY OPEN 2023; 4:e269. [PMID: 37600881 PMCID: PMC10431296 DOI: 10.1097/as9.0000000000000269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/02/2023] [Indexed: 03/19/2023] Open
Affiliation(s)
- Masato Fujiki
- From the Department of General Surgery, Transplant Center, Cleveland Clinic, Cleveland, OH
| | - Koji Hashimoto
- From the Department of General Surgery, Transplant Center, Cleveland Clinic, Cleveland, OH
| | - Federico Aucejo
- From the Department of General Surgery, Transplant Center, Cleveland Clinic, Cleveland, OH
| | - Choon Hyuck David Kwon
- From the Department of General Surgery, Transplant Center, Cleveland Clinic, Cleveland, OH
| | - Bijan Eghtesad
- From the Department of General Surgery, Transplant Center, Cleveland Clinic, Cleveland, OH
| | - Charles Miller
- From the Department of General Surgery, Transplant Center, Cleveland Clinic, Cleveland, OH
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Kitajima T, Rajendran L, Lisznyai E, Lu M, Shamaa T, Ivanics T, Yoshida A, Claasen MPAW, Abouljoud MS, Sapisochin G, Nagai S. Lymphopenia at the time of transplant is associated with short-term mortality after deceased donor liver transplantation. Am J Transplant 2023; 23:248-256. [PMID: 36804132 DOI: 10.1016/j.ajt.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/06/2022] [Accepted: 10/28/2022] [Indexed: 01/13/2023]
Abstract
Absolute lymphocyte count (ALC) is considered a surrogate marker for nutritional status and immunocompetence. We investigated the association between ALC and post-liver transplant outcomes in patients who received a deceased donor liver transplant (DDLT). Patients were categorized by ALC at liver transplant: low (<500/μL), mid (500-1000/μL), and high ALC (>1000/μL). Our main analysis used retrospective data (2013-2018) for DDLT recipients from Henry Ford Hospital (United States); the results were further validated using data from the Toronto General Hospital (Canada). Among 449 DDLT recipients, the low ALC group demonstrated higher 180-day mortality than mid and high ALC groups (83.1% vs 95.8% and 97.4%, respectively; low vs mid: P = .001; low vs high: P < .001). A larger proportion of patients with low ALC died of sepsis compared with the combined mid/high groups (9.1% vs 0.8%; P < .001). In multivariable analysis, pretransplant ALC was associated with 180-day mortality (hazard ratio, 0.20; P = .004). Patients with low ALC had higher rates of bacteremia (22.7% vs 8.1%; P < .001) and cytomegaloviremia (15.2% vs 6.8%; P = .03) than patients with mid/high ALC. Low ALC pretransplant through postoperative day 30 was associated with 180-day mortality among patients who received rabbit antithymocyte globulin induction (P = .001). Pretransplant lymphopenia is associated with short-term mortality and a higher incidence of posttransplant infections in DDLT patients.
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Affiliation(s)
- Toshihiro Kitajima
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Luckshi Rajendran
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Eric Lisznyai
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Mei Lu
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Tayseer Shamaa
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Tommy Ivanics
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Health System, Detroit, Michigan, USA; Multi-Organ Transplant Program, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Sciences, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden
| | - Atsushi Yoshida
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Marco P A W Claasen
- Multi-Organ Transplant Program, University of Toronto, Toronto, Ontario, Canada
| | - Marwan S Abouljoud
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Gonzalo Sapisochin
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, Ontario, Canada; Multi-Organ Transplant Program, University of Toronto, Toronto, Ontario, Canada
| | - Shunji Nagai
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Health System, Detroit, Michigan, USA.
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Zirpe KG, Tiwari AM, Pandit RA, Govil D, Mishra RC, Samavedam S, Gopal PB, Kulkarni AP, Swaminathan S, Dixit SB, Kar A, Pande RK, Chaudhry D. Recommendations for Evaluation and Selection of Deceased Organ Donor: Position Statement of ISCCM. Indian J Crit Care Med 2022; 26:S43-S50. [PMID: 36896361 PMCID: PMC9989874 DOI: 10.5005/jp-journals-10071-24190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022] Open
Abstract
There is a wide gap between patients who need transplants and the organs that are available in India. Extending the standard donation criterion is certainly important to address the scarcity of organs for transplantation. Intensivists play a major role in the success of deceased donor organ transplants. Recommendations for deceased donor organ evaluation are not discussed in most intensive care guidelines. The purpose of this position statement is to establish current evidence-based recommendations for multiprofessional critical care staff in the evaluation, assessment, and selection of potential organ donors. These recommendations will give "real-world" criteria that are acceptable in the Indian context. The aim of this set of recommendations is to both increase the number and enhance the quality of transplantable organs. How to cite this article Zirpe KG, Tiwari AM, Pandit RA, Govil D, Mishra RC, Samavedam S, et al. Recommendations for Evaluation and Selection of Deceased Organ Donor: Position Statement of ISCCM. Indian J Crit Care Med 2022;26(S2):S43-S50.
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Affiliation(s)
- Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Anand M Tiwari
- Department of Neuro Trauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Rahul A Pandit
- Department of Critical Care Medicine, Fortis Hospital, Mumbai, Maharashtra, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesia, Medanta - The Medicity, Gurugram, Haryana, India
| | - Rajesh C Mishra
- Department of MICU, Shaibya Comprehensive Care Clinic, Ahmedabad, Gujarat, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
| | | | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Subhal B Dixit
- Department of Critical Care, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Arindam Kar
- Calcutta Medical Research Institute, Kolkata, West Bengal, India
| | - Rajesh K Pande
- Department of Critical Care, BLK Superspeciality Hospital, New Delhi, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India
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7
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Silverstein J, Yao FY, Grab JD, Braun HJ, Roberts J, Dodge JL, Mehta N. National experience with living donor liver transplantation for hepatocellular carcinoma. Liver Transpl 2022; 28:1144-1157. [PMID: 35226793 DOI: 10.1002/lt.26439] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/10/2022] [Accepted: 01/20/2022] [Indexed: 01/13/2023]
Abstract
Living donor liver transplantation (LDLT) is an attractive option to decrease waitlist dropout, particularly for patients with hepatocellular carcinoma (HCC) who face lengthening waiting times. Using the United Network for Organ Sharing (UNOS) national database, trends in LDLT utilization for patients with HCC were evaluated, and post-LT outcomes for LDLT versus deceased donor liver transplantation (DDLT) were compared. From 1998 to 2018, LT was performed in 20,161 patients with HCC including 726 (3.6%) who received LDLT. The highest LDLT utilization was prior to the 2002 HCC Model for End-Stage Liver Disease (MELD) exception policy (17.5%) and dropped thereafter (3.1%) with a slight increase following the 6-month wait policy in 2015 (3.8%). LDLT was more common in patients from long-wait UNOS regions with blood type O, in those with larger total tumor diameter (2.3 vs. 2.1 cm, p = 0.02), and higher alpha-fetoprotein at LT (11.5 vs. 9.0 ng/ml, p = 0.04). The 5-year post-LT survival (LDLT 77% vs. DDLT 75%), graft survival (72% vs. 72%), and HCC recurrence (11% vs. 13%) were similar between groups (all p > 0.20). In conclusion, LDLT utilization for HCC has remained low since 2002 with only a slight increase after the 6-month wait policy introduction in 2015. Given the excellent post-LT survival, LDLT appears to be an underutilized but valuable option for patients with HCC, especially those at high risk for waitlist dropout.
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Affiliation(s)
- Jordyn Silverstein
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Francis Y Yao
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Joshua D Grab
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Hillary J Braun
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - John Roberts
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jennifer L Dodge
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California, USA.,Department of Gastroenterology and Liver Diseases, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Neil Mehta
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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8
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Ikegami T, Haruki K, Furukawa K, Onda S. Left Lobe Living Donor Graft Could Be a Good Choice for Liver Transplantation. Liver Transpl 2021; 27:1215-1216. [PMID: 33834627 DOI: 10.1002/lt.26064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/06/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Toru Ikegami
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Koichiro Haruki
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenei Furukawa
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinji Onda
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
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9
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Kitajima T, Moonka D, Yeddula S, Collins K, Rizzari M, Yoshida A, Abouljoud MS, Nagai S. Reply. Liver Transpl 2021; 27:1217-1218. [PMID: 33786986 DOI: 10.1002/lt.26058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Toshihiro Kitajima
- Divisions of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI
| | - Dilip Moonka
- Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, MI
| | - Sirisha Yeddula
- Divisions of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI
| | - Kelly Collins
- Divisions of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI
| | - Michael Rizzari
- Divisions of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI
| | - Atsushi Yoshida
- Divisions of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI
| | - Marwan S Abouljoud
- Divisions of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI
| | - Shunji Nagai
- Divisions of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI
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10
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Roll GR, Roberts JP. With the Proven Tenacity of Waitlist Mortality, Shouldn't We Resist the Urge to Make Mountains Out of Survival Statistic Molehills? Liver Transpl 2021; 27:955-956. [PMID: 33561897 DOI: 10.1002/lt.26007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Garrett R Roll
- Department of Surgery, Division of Transplant, University of California San Francisco, San Francisco, CA
| | - John P Roberts
- Department of Surgery, Division of Transplant, University of California San Francisco, San Francisco, CA
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