A decade of right liver adult-to-adult live donor liver transplantation: mid-term outcomes

Abstract

Introduction: Right liver adult-to-adult live donor liver transplantation debuted a decade ago is now due for mid-term outcomes appraisal. Patients and methods Consecutive liver transplant cases with a minimum follow-up of 2 years in Queen Mary Hospital, the University of Hong Kong from May 1996 to December 2004 were included (N=188). The data including recipient and graft characteristics were collected prospectively and were analyzed retrospectively. From 1996 to 2000, fewer than 30 cases per year were determined early era. Results: This series had a median followup of 48 months. The early era included 28 cases and the latter era 160 cases. Recipients of the early era were slightly younger (42 yr vs. 48 yr, p = 0.002) and fewer of them suffered from hepatocellular carcinoma (HCC) (10.7% vs. 29.4%, p = 0.039). Disease severity was worse as refl ected by a higher proportion of recipients with hepatorenal syndrome (35.7% vs. 16.3%, p = 0.016), and higher Model of End-stage Liver Disease scores (34 vs. 26, p = 0.007). Graft characteristics were similar. The recipients of the early era had higher hospital mortalities (6/28 vs. 4/160, p = 0.001). Transplantation in the high urgency situation did not result in higher hospital mortality (5/91 vs. 5/97, p = 0.917). None of the recipients transplanted for HCC had hospital mortality (0/50 vs. 10/138, p= 0.065). On univariate analysis, the presence of HCC and transplantation in the early era were of adverse factors for survival. This was verifi ed by a multivariate analysis which indicated that early era (RR = 2.824, p = 0.015) and HCC (RR = 2.897, p = 0.005) were factors adversely affecting overall survival. The 1-, 3-, and 5-year overall survivals were 92.5%, 86.3%, and 82.3%, respectively. When recipients with hospital mortality and transplanted for HCC were excluded, the 1-, 3-, and 5-year overall survivals became 97.6%, 95.3%, and 95.3%, respectively. Recipients with HCC (n = 50) and only those who were within the Milan criteria (n = 34) had 1-, 3-, and 5-year survivals of 98.0%, 80.5%, and 63.4%; and 97.1%, 85.0%, and, 67.6%, respectively. Conclusion: This operation resulted in predictably high 5-year survival in particular when hospital mortality could be avoided after maturation of techniques and careful case selection of recipients with a low chance of recurrence from HCC.