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Yeow MWX, Pang NQ, Bonney GK, Madhavan K, Kow WCA, Iyer SG. Living donor hepatectomy in medium volume liver transplant centre has comparable outcomes to high volume centres: validation of donabedian quality assurance framework. HPB (Oxford) 2022; 24:516-524. [PMID: 34544630 DOI: 10.1016/j.hpb.2021.08.946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Given the complexity of living donor hepatectomy, it is expected that high hospital volume will better outcomes. This study aims to evaluate post-operative outcomes for living donor hepatectomy in a medium volume liver transplant centre and compare to outcomes in high volume centres. Also, it serves as a validation tool for framework of structure-process-outcome model for safe living donor hepatectomy program. METHODS 204 donors who underwent donor hepatectomy between June 1996 to September 2019 were reviewed retrospectively and compared to outcomes in high volume centres. RESULTS At 6 months, overall donor morbidity rate was 20/204 (9.8%). Wound complications were most common at 5/204 (2.5%). Majority of complications were either Clavien grade 1 or 2 and only 3 donors had Clavien grade 3 complications. There was zero donor mortality. DISCUSSION Our centre's donor morbidity rate of 9.8% is the one of the lowest reported in the published literature. With increased experience, stringent donor selection and enhanced perioperative care by a multi-disciplinary team, outcomes in a medium volume centre can match the outcomes reported in high volume centres. The framework for quality in terms of structure, process and outcomes is presented which can be adopted for developing programs.
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Affiliation(s)
| | - Ning Q Pang
- Division of Hepatobiliary, Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Health System, Singapore; National University Centre for Organ Transplantation, National University Hospital, Singapore
| | - Glenn K Bonney
- Division of Hepatobiliary, Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Health System, Singapore; National University Centre for Organ Transplantation, National University Hospital, Singapore
| | - Krishnakumar Madhavan
- Division of Hepatobiliary, Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Health System, Singapore; National University Centre for Organ Transplantation, National University Hospital, Singapore
| | - Wei Chieh Alfred Kow
- Division of Hepatobiliary, Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Health System, Singapore; National University Centre for Organ Transplantation, National University Hospital, Singapore
| | - Shridhar Ganpathi Iyer
- Division of Hepatobiliary, Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Health System, Singapore; National University Centre for Organ Transplantation, National University Hospital, Singapore.
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Yankol Y, Mecit N, Kanmaz T, Kalayoğlu M, Acarlı K. Complications and outcomes of 890 living liver donor hepatectomies at a single center: risks of saving loved one's life. Turk J Surg 2020; 36:192-201. [PMID: 33015564 DOI: 10.5578/turkjsurg.4548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/27/2019] [Indexed: 12/13/2022]
Abstract
Objectives Living liver donor surgery is a major surgical procedure applied to healthy people with mortality and morbidity risks and does not provide any direct therapeutic advantage to the donor. We retrospectively analyzed the postoperative complication of our living liver donors to figure out the risks of donation. Material and Methods Between November, 2006 and December, 2018, a total of 939 living liver donor hepatectomies were performed with no mortality to the living-related donors. Eight hundred and ninety donors with a minimum 1-year follow-up were analyzed retrospectively. Results Of the 890 donors, 519 (58.3%) were males and 371 (41.7%) were females. Mean age was 35 years (18-64) and mean body mass index was 25.7 kg/m2 (17.7-40). Right donor hepatectomy was performed to 601 (67.5%), left donor hepatectomy to 28 (3.2%) and left lateral sector hepatectomy to 261 (29.3%) of the donors. Of the 890 donors, 174 (19.5%) donors experienced a total of 204 early and late complications including life- threatening and nearly life- threatening complications in 26 (2.9%) of them. Intraoperative complication occurred in 4 (0.5%) donors. Right donors hepatectomy complication rate (23.3%) was higher than left donor (14.3%) and left lateral sector donor hepatectomy (11.5%). Conclusion All donor candidates should be well-informed not only on the details of early and late complications of living liver donation, also possible outcomes of the recipient. In addition to detailed physical evaluation, preoperative psychosocial evaluation is also mandatory. Comprehensive donor evaluation, surgical experience, surgical technique, close postoperative follow-up and establishing a good dialog with the donor allows better outcomes.
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Affiliation(s)
- Yücel Yankol
- Organ Transplantation Center, Memorial Sisli Hospital, Istanbul, Turkey.,Department of Surgery Division of Transplantation, University of Wisconsin, Madison, WI, United States of America
| | - Nesimi Mecit
- Organ Transplantation Center, Memorial Sisli Hospital, Istanbul, Turkey.,Organ Transplantation Center, Koc University School of Medicine Hospital, Istanbul, Turkey
| | - Turan Kanmaz
- Organ Transplantation Center, Memorial Sisli Hospital, Istanbul, Turkey.,Organ Transplantation Center, Koc University School of Medicine Hospital, Istanbul, Turkey
| | - Münci Kalayoğlu
- Organ Transplantation Center, Memorial Sisli Hospital, Istanbul, Turkey.,Organ Transplantation Center, Koc University School of Medicine Hospital, Istanbul, Turkey
| | - Koray Acarlı
- Organ Transplantation Center, Memorial Sisli Hospital, Istanbul, Turkey
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3
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Zeytunlu M, Uğuz A, Ünalp Ö, Ergün O, Karasu Z, Günşar F, Akarca U, Yılmaz F, Turan İ, Nart D, Tekin F, Özütemiz Ö, Ulukaya S, Deniz N, Aydoğdu S, Özgenç F, Tasçı E, Sertöz R, Parıldar M, Elmas N, Harman M, Güler E, Kısmalı E, Akyol R, Yamazhan T, Taşbakan M, Tiftikcioğlu Y, Bacakoğlu F, Nalbantgil S, Noyan A, Karapınar B, Kılınç A, Uyar M, Demirağ K, Özalp S, Özdemir N, Aras S, Altuğ N. Results of 1001 liver transplantations in 23 years: Ege University experience. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2018; 29:664-668. [PMID: 30381274 PMCID: PMC6284687 DOI: 10.5152/tjg.2018.18058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/15/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND/AIMS Liver transplantation (LT) is now the standard of care for most end-stage liver diseases. Over the next 30 years, advances in medicine and technology will greatly improve the survival rates of patients after this procedure. The aim of the present study was to analyze retrospectively the results of 1001 patients withLT. MATERIALS AND METHODS Medical reports of 989 patients were analyzed retrospectively. Data were obtained from the patient's data chart. Descriptive statistics were used to describe continuous variables (mean, median, and standard deviation). RESULTS A total of 1001 LTs for 989 recipients were performed at Ege University Organ Transplantation and Research Center between 1994 and 2017. Therewere 639 male and 350 female recipients. Among 1001 LTs, there were 438 deceased donors and 563 living donors. The age interval of the patients was 4 months to 71 years old. The median Model for End-Stage Liver Disease score was 20. There were 12 deceased liver donors using the split method. There were 12 cases subject to retransplantation. In living donor LT grafts, 423 right lobes, 46 left lobes, and 94 left lateral sectors were used. In the first monitoring,the total annual mortality rate was 130 cases (13%). The mortality rate in retransplantation was found to be 66%. A 1-year survival rate of 87% was generally stablished. CONCLUSION LThas been improving consistently over the last two decades. Ege University is one of the biggest liver transplant centers in Turkey for both technical and educational perspective.
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Affiliation(s)
- Murat Zeytunlu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Alper Uğuz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ömer Ünalp
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Orkan Ergün
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Zeki Karasu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Fulya Günşar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ulus Akarca
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Funda Yılmaz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - İlker Turan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Deniz Nart
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Fatih Tekin
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ömer Özütemiz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sezgin Ulukaya
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nuri Deniz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sema Aydoğdu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Funda Özgenç
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ezgi Tasçı
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Rüçhan Sertöz
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Mustafa Parıldar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nevra Elmas
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Mustafa Harman
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ezgi Güler
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Erkan Kısmalı
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Rahmi Akyol
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Tansu Yamazhan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Meltem Taşbakan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Yiğit Tiftikcioğlu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Feza Bacakoğlu
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sanem Nalbantgil
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Ayşin Noyan
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Bülent Karapınar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Arda Kılınç
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Mehmet Uyar
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Kubilay Demirağ
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sibel Özalp
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nebile Özdemir
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Sinem Aras
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
| | - Nurşen Altuğ
- Liver Transplantation Department of Organ Transplantation and Research Center, Ege University School of Medicine, İzmir, Turkey
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Pedersen R, Sung M, Difronzo AL. Long-Term Nononcologic Outcomes for Laparoscopic Liver Resection: Improvement over Open Hepatectomy? Am Surg 2016. [DOI: 10.1177/000313481608201020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Prior studies of laparoscopic liver resection (LLR) have evaluated long-term outcomes in terms of cancer survival, but few have evaluated nononcologic outcomes. This study analyzes long-term nondisease-specific complications associated with LLR and open liver resection (OLR). We performed a retrospective single-institution review of patients undergoing liver resection for any reason from January 2005 to December 2014. Long-term complication was defined as any complication not related to the primary disease process, and occurring more than 90 days after surgery, emphasizing incisional hernia (IH) and small bowel obstruction (SBO). A total of 208 patients were included in the OLR group and 79 patients in the LLR group. Forty-one patients (19.6%) developed IH after OLR, whereas only six patients (7.5%) developed IH after LLR ( P = 0.01). About 3.8 per cent of patients developed IH requiring surgical repair in both groups. Seven patients developed SBO (3.4%) after OLR; no patient developed SBO after LLR. Median time to development of complications was 13.8 months (range 3–54 months) after OLR compared with 8.5 months after LLR (range 6–36 months). Male gender, body mass index, prior abdominal surgery, and OLR were independent risk factors for development of long-term complications. There is a higher incidence of nondisease-specific complications after OLR than LLR.
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Affiliation(s)
- Rose Pedersen
- From Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Michael Sung
- From Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Andrew L. Difronzo
- From Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
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