Early and late graft loss after right lobe living donor liver transplantation – a 20-year single centre experience

Abstract

Introduction: Right lobe living donor liver transplantation (RLDLT) was first reported in 1997 and we reviewed our centre experience of RLDLT after 20 years. Patients and methods: Retrospective study of all RLDLT at the Department of Surgery, Queen Mary Hospital, Hong Kong was performed. Result: From 1996 - 2015, 517 patients underwent RLDLT. Early graft loss < =3 months occurred in 12/ 219 patients (5.5%) in Era I (1996-2005) and 7/298 patients (2.3%) in Era II (2006-2015) (p = 0.062). Main causes of early graft loss in the Era 1 were sepsis in 6 patients (50%) and portal vein thrombosis in 3 patients (25%) while those in Era II were myocardial infarction in 3 patients (42.9%) and sepsis in 2 (28.6%). Late graft loss > 3 months occurred in 49 patients (22.4%) in Era I and 36 patients (12.1%) in Era II (p= 0.002). Main causes of late graft loss in Era I were recurrent HCC in 19 patients (38.8%), pulmonary complications in 5 (10.2%), vascular complication in 5 (10.2%) and bile duct complication in 5 patients (10.2%) while those in Era II were recurrent HCC in 13 (36.1%) and pulmonary complications in 7 patients (19.4%). The 1-year, 3-year, 5-year and 10-year graft survival was 92.7%, 85.4%, 81.3% and 76.3% for Era I (1996-2005) and 94%, 89.9%, 86.4% and 84.3% for Era II (2006-2015) (p=0.058). The respective patient survival was 93.6%, 86.3%, 83.1% and 77.5% for Era I and 94.6%, 90.6%, 87.5% and 85.3% for Era II (p=0.076). Conclusion: RLDLT is associated with good long term outcome which also improves with time. Causes of early graft loss has shifted from surgically related complications to medical condition of the patients. HCC recurrence remained a major issue resulting in late graft loss.