Liver transplantation epidemiology and demographics: Difference between revisions

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{{CMG}}; {{AE}} {{MAD}}
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{{Liver transplantation}}
{{Liver transplantation}}


==Overview==
==Overview==
'''Incidence'''
* Acoording to United Network for Organ Sharing, 2753 adult LDLT and 1283 pediatric LDLT had been performed in the USA till February 2010.
* The most common indication for transplantation was primary sclerosing cholangitis (37.7%).
=== Survival rates ===
* Survival rates at 10 years was 70% for LDLT and 64% for DDLT. 
* For all recipients female gender and primary sclerosing cholangitis were associated with improved survival while dialysis and older recipient/donor age were associated with worse survival.
* LDLT recipients had longer total operative time and shorter total ischemia time median 98 minutes vs 487 minutes, than DDLT recipients.
* Intraoperative blood transfusion requirements were lower in LDLT compared to DDLT. 
* Smaller graft size has higher technical complexity, the graft and patient survival rates of patients with right-liverLDLT are not different from those of patients receiving whole-graft DDLT. 
* Critically ill adult recipients with advanced liver failure, high MELD scores, and numerous secondary complications have generally been reported to have worse outcomes with this procedure.
=== Morbidity and mortality ===
* Seven donor deaths have been reported till 2010 in the USA and 19 deaths worldwide.
* The overall mortality rate of liver transplantation is of the order of 0.2–0.5%.
* The risk associated with left-lobe donation may be lower than that with right-lobe donation.
* The incidence of complications in the donor varies in the literature from 9 to 67%, but is likely in the 30% range.
* The Adult Living Donor Liver Transplantation Cohort Study reported a donor complication rate of 38%; 21% of donors had one complication and 17% had two or more.
=== Complications ===
Common complications include:
* Biliary leaks beyond postoperative day 7 (9%)
* bacterial infections (12%)
* incisional hernia (6%)
* pleural effusion requiring intervention (5%)
* neuropraxia (4%)
* reexploration (3%)
* wound infections (3%)
* Intraabdominal abscess (2%)


==references==
==References==

Latest revision as of 20:04, 28 December 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

Liver trasnsplantation Microchapters

Home

Patient Information

Overview

Historical Perspective

Indications

Pre-surgical management

Choice of donor

Epidemiology and Demographics

Techniques

Complications

Acute rejection

Immune therapy

Post-surgical infection

Prognosis

Overview

Incidence

  • Acoording to United Network for Organ Sharing, 2753 adult LDLT and 1283 pediatric LDLT had been performed in the USA till February 2010.
  • The most common indication for transplantation was primary sclerosing cholangitis (37.7%).

Survival rates

  • Survival rates at 10 years was 70% for LDLT and 64% for DDLT.
  • For all recipients female gender and primary sclerosing cholangitis were associated with improved survival while dialysis and older recipient/donor age were associated with worse survival.
  • LDLT recipients had longer total operative time and shorter total ischemia time median 98 minutes vs 487 minutes, than DDLT recipients.
  • Intraoperative blood transfusion requirements were lower in LDLT compared to DDLT. 
  • Smaller graft size has higher technical complexity, the graft and patient survival rates of patients with right-liverLDLT are not different from those of patients receiving whole-graft DDLT.
  • Critically ill adult recipients with advanced liver failure, high MELD scores, and numerous secondary complications have generally been reported to have worse outcomes with this procedure.

Morbidity and mortality

  • Seven donor deaths have been reported till 2010 in the USA and 19 deaths worldwide.
  • The overall mortality rate of liver transplantation is of the order of 0.2–0.5%.
  • The risk associated with left-lobe donation may be lower than that with right-lobe donation.
  • The incidence of complications in the donor varies in the literature from 9 to 67%, but is likely in the 30% range.
  • The Adult Living Donor Liver Transplantation Cohort Study reported a donor complication rate of 38%; 21% of donors had one complication and 17% had two or more.

Complications

Common complications include:

  • Biliary leaks beyond postoperative day 7 (9%)
  • bacterial infections (12%)
  • incisional hernia (6%)
  • pleural effusion requiring intervention (5%)
  • neuropraxia (4%)
  • reexploration (3%)
  • wound infections (3%)
  • Intraabdominal abscess (2%)

References

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