08 September 2017 : Original article
Significance of Proper Graft Selection in Adult Living-Donor Liver Transplant Recipients with Preoperative Deteriorated Condition
Taku Iida12ABCE*, Koji Masuda1B, Takehisa Matsuyama1B, Shumpei Harada1B, Tsukasa Nakamura1B, Katsuhiro Koshino1B, Tomoyuki Suzuki1B, Shuji Nobori1B, Hidetaka Ushogome1B, Takashi Ito12B, Seisuke Sakamoto12B, Kenji Uryuhara12B, Hideaki Okajima12B, Satoshi Kaihara12B, Shinji Uemoto2B, Norio Yoshimura1ABDDOI: 10.12659/AOT.904575
Ann Transplant 2017; 22:541-549
Abstract
BACKGROUND: The outcome of living-donor liver transplantation (LDLT) is poor for recipients with severely deteriorated preoperative condition. This study therefore evaluated the proper graft selection according to the recipients’ preoperative condition.
MATERIAL AND METHODS: We evaluated the clinical outcomes in 66 patients who underwent adult LDLT from October 2003 to June 2016 in our institution, excluding fulminant liver failure and ABO-incompatible cases. Preoperative risk factors included MELD score >20, preoperative hospitalization for over 2 weeks or intensive care unit admission and bacterial infection within 1 month before LDLT. Patients were classified into those with 0–1 risk factors (Group LR, n=44) and those with 2–3 risk factors (Group HR, n=22).
RESULTS: The overall survival (OS) rate after LDLT was significantly lower in Group HR than in Group LR (1-year: HR 83.9% vs. LR 93%, 3-year: HR 70.8% vs. LR 90.5%, 5-year: HR 62% vs. LR 87.6%; p=0.029). In Group LR, OS rates did not differ significantly by graft type or donor age. In Group HR, OS rates at 1 (93.8% vs. 66.7%), 3 (85.2% vs. 50%), and 5 (75.8% vs. 25%) years were significantly higher using right (n=16) vs. left (n=6) lobe grafts (p=0.046).
CONCLUSIONS: Proper graft selection is very important to improve the outcome of LDLT recipients in deteriorated preoperative condition. LDLT using right-lobe grafts may be recommended for high-risk severely deteriorated patients.
Keywords: Graft Survival, Liver Transplantation, Transplantation
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