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]
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Liver trasnsplantation Microchapters |
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%)