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Article: Determinants of Hospital Mortality of Adult Recipients of Right Lobe Live Donor Liver Transplantation

TitleDeterminants of Hospital Mortality of Adult Recipients of Right Lobe Live Donor Liver Transplantation
Authors
Issue Date2003
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com
Citation
Annals Of Surgery, 2003, v. 238 n. 6, p. 864-870 How to Cite?
AbstractObjective: To define the technical factors that might contribute to hospital mortality of recipients of right lobe live donor liver transplantation (LDLT) so as to perfect the design of the operation. Summary Background Data: Right lobe LDLT has been accepted as one of the treatments for patients with terminal hepatic failure, but the design and results of the reported series vary and the technical factors affecting hospital mortality have not been known. Methods: The data of 100 adult-to-adult right lobe LDLT performed between 1996 and 2002 were prospectively collected and retrospectively analyzed. All grafts except one contained the middle hepatic vein, which was anastomosed to the recipient middle/left hepatic vein in the first 84 recipients and directly into the inferior vena cava (with the right hepatic vein in form of venoplasty) in the subsequent 15 patients. Venovenous bypass was used routinely in the first 29 patients but not subsequently. Results: Eight patients died within the same hospital admission for liver transplantation. There was no hospital mortality in the last 53 recipients. Comparison of data of patients with or without hospital mortality showed that graft weight/body weight ratio, graft weight/ estimated standard liver weight ratio, technical error resulting in occlusion/absence of the middle hepatic vein, use of venovenous bypass, the lowest body temperature recorded during surgery, the volume of intraoperative blood transfusion, fresh frozen plasma, and platelet infusion were significantly different between the two groups. However, the pretransplant intensive care unit status of the recipients, cold and warm ischemic time of the graft, and occurrence of biliary complications were not. By multivariate analysis, low body temperature recorded during operation, low graft weight/estimated standard liver weight ratio (≤0.35), and the middle hepatic vein occlusion were independent significant factors in determining hospital mortality. Conclusions: To achieve a uniformly successful right lobe LDLT, the right lobe graft must contain a patent middle hepatic vein. With a completely patent middle hepatic vein, a graft size of >35% of the estimated standard graft weight may be sufficient for recipient survival. Hypothermia, which predisposes to coagulopathy and is enhanced by the use of venovenous bypass and massive blood, and blood product transfusion must be avoided.
Persistent Identifierhttp://hdl.handle.net/10722/48945
ISSN
2015 Impact Factor: 8.569
2015 SCImago Journal Rankings: 4.503
PubMed Central ID
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorFan, STen_HK
dc.contributor.authorLo, CMen_HK
dc.contributor.authorLiu, CLen_HK
dc.contributor.authorYong, BHen_HK
dc.contributor.authorWong, Jen_HK
dc.contributor.authorBelghiti, JBen_HK
dc.contributor.authorStarzl, THEen_HK
dc.contributor.authorMakuuchi, Men_HK
dc.date.accessioned2008-06-12T06:30:20Z-
dc.date.available2008-06-12T06:30:20Z-
dc.date.issued2003en_HK
dc.identifier.citationAnnals Of Surgery, 2003, v. 238 n. 6, p. 864-870en_HK
dc.identifier.issn0003-4932en_HK
dc.identifier.urihttp://hdl.handle.net/10722/48945-
dc.description.abstractObjective: To define the technical factors that might contribute to hospital mortality of recipients of right lobe live donor liver transplantation (LDLT) so as to perfect the design of the operation. Summary Background Data: Right lobe LDLT has been accepted as one of the treatments for patients with terminal hepatic failure, but the design and results of the reported series vary and the technical factors affecting hospital mortality have not been known. Methods: The data of 100 adult-to-adult right lobe LDLT performed between 1996 and 2002 were prospectively collected and retrospectively analyzed. All grafts except one contained the middle hepatic vein, which was anastomosed to the recipient middle/left hepatic vein in the first 84 recipients and directly into the inferior vena cava (with the right hepatic vein in form of venoplasty) in the subsequent 15 patients. Venovenous bypass was used routinely in the first 29 patients but not subsequently. Results: Eight patients died within the same hospital admission for liver transplantation. There was no hospital mortality in the last 53 recipients. Comparison of data of patients with or without hospital mortality showed that graft weight/body weight ratio, graft weight/ estimated standard liver weight ratio, technical error resulting in occlusion/absence of the middle hepatic vein, use of venovenous bypass, the lowest body temperature recorded during surgery, the volume of intraoperative blood transfusion, fresh frozen plasma, and platelet infusion were significantly different between the two groups. However, the pretransplant intensive care unit status of the recipients, cold and warm ischemic time of the graft, and occurrence of biliary complications were not. By multivariate analysis, low body temperature recorded during operation, low graft weight/estimated standard liver weight ratio (≤0.35), and the middle hepatic vein occlusion were independent significant factors in determining hospital mortality. Conclusions: To achieve a uniformly successful right lobe LDLT, the right lobe graft must contain a patent middle hepatic vein. With a completely patent middle hepatic vein, a graft size of >35% of the estimated standard graft weight may be sufficient for recipient survival. Hypothermia, which predisposes to coagulopathy and is enhanced by the use of venovenous bypass and massive blood, and blood product transfusion must be avoided.en_HK
dc.format.extent388 bytes-
dc.format.mimetypetext/html-
dc.languageengen_HK
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.comen_HK
dc.relation.ispartofAnnals of Surgeryen_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subject.meshHospital Mortalityen_HK
dc.subject.meshLiver Transplantation - mortalityen_HK
dc.subject.meshLiving Donorsen_HK
dc.subject.meshLogistic Modelsen_HK
dc.subject.meshRetrospective Studiesen_HK
dc.titleDeterminants of Hospital Mortality of Adult Recipients of Right Lobe Live Donor Liver Transplantationen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0003-4932&volume=238&issue=6&spage=864&epage=870&date=2003&atitle=Determinants+of+hospital+mortality+of+adult+recipients+of+right+lobe+live+donor+liver+transplantationen_HK
dc.identifier.emailFan, ST: stfan@hku.hken_HK
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.authorityFan, ST=rp00355en_HK
dc.identifier.authorityLo, CM=rp00412en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1097/01.sla.0000098618.11382.77en_HK
dc.identifier.pmid14631223-
dc.identifier.pmcidPMC1356168en_HK
dc.identifier.scopuseid_2-s2.0-0842289172en_HK
dc.identifier.hkuros92212-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0842289172&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume238en_HK
dc.identifier.issue6en_HK
dc.identifier.spage864en_HK
dc.identifier.epage870en_HK
dc.identifier.isiWOS:000186748500018-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridFan, ST=7402678224en_HK
dc.identifier.scopusauthoridLo, CM=7401771672en_HK
dc.identifier.scopusauthoridLiu, CL=7409789712en_HK
dc.identifier.scopusauthoridYong, BH=7003644314en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK
dc.identifier.scopusauthoridBelghiti, JB=35403099400en_HK
dc.identifier.scopusauthoridStarzl, ThE=35403289700en_HK
dc.identifier.scopusauthoridMakuuchi, M=36050194500en_HK

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