Liver transplantation epidemiology and demographics

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

Liver trasnsplantation Microchapters
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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

Donor mortality

As of February 28, 2010, 2753 adult and 1283 pediatric LDLTs had been performed in the USA and reported to United Network for Organ Sharing. [1],

among which were seven donor deaths (0.2%) [10 ]

By some reports, there have been 19 deaths worldwide [30]

the overall mortality rate 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 [31–36].

The Adult Living Donor Liver Transplantation Cohort Study

(A2ALL), funded by the National Institutes of Health, with nine livertransplant

centers, reported a donor complication rate of 38%; 21% of donors had one complication and 17% had two or more.

Common complications included 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%), and intraabdominal abscess (2%).

Two donors developed portal-vein thrombosis and one had inferior venacaval

thrombosis; 13% of donors required hospital readmission and 4%

required two to five readmissions [36].

Bile leaks and strictures have been reported in roughly 10 and 3%

of donors, respectively.

Living-donor recipients have been noted to have a higher incidence of surgical complications post-transplant compared with whole-liver recipients. [39]

Smaller graft size and higher technical complexity, the graft and patient survival rates of patients with right-liverLDLTare not different from those of patients receiving whole-graft DDLT [40,41].

The only difference is a higher incidence of biliary complications in the LDLT patients. [40]

Most centers have reported a 15–46% incidence of biliary complications, including early bile leaks, after transplant, and a 15–20% incidence of late biliary strictures.

These figures are significantly higher than are generally reported for whole-liver recipients (9–15%) [40]

the incidence of vascular complications such as hepatic artery thrombosis has decreased and is now not significantly different from that in deceased-liver transplants. [44–47]

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. [40].

The epidemiology of infections after living donor liver transplantation (LDLT) is limited.

We aimed to study the epidemiology and risk factors of infections after LDLT.

The most common indication for transplantation was primary sclerosing cholangitis (37.7%).

A total of 122 patients developed an infection during the follow-up period (1-year cumulative event rate of 56%), with the majority (66%) of these occurring within 30 days after transplantation.

Enterococcus sp. was the most frequent pathogen identified.

Survival probability at 10 years was 70% for LDLT and 64% for DDLT.

Post-transplant ICU days were less for LDLT.

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.

Higher MELD score was associated with increased graft failure. Era of transplantation and type of donated lobe did not impact survival in LDLT.

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.