Liver transplantation prognosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
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Liver trasnsplantation Microchapters |
Overview
Liver transplantation prognosis
Living-donor recipients have been noted to have a higher incidence of surgical complications post-transplant compared with whole-liver recipients.
Early data suggested that outcomes (graft survival) might be inferior to those in whole-liver transplants, especially if the patients were matched for severity of liver disease [39].
Partial grafts have smaller vessels, more complicated biliary reconstructions, and a cut surface, all of which make for a technically more challenging procedure and a higher incidence of surgical complications.
Maluf et al. and Fan et al. reported that despite 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 (25.8 versus 7.1%) [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 possible factors associated with an increased risk of postoperative biliary complications include having multiple bile ducts to reconstruct and an inadequate arterial perfusion in patients with a high preoperative MELD score [42,43].
With advances in microsurgical techniques, 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]. Certain subgroups of recipients may do worse after living-donor transplants. 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. Such recipients have minimal functional reserve and are probably ill equipped to manage the lower hepatocyte mass and the higher complication rate associated with partial transplants. However, in parts of the world where DDLTs are uncommon, living donors have been used for critically ill patients, with good results [40].