TITLE: OUTCOME RESULTS OF ADULT LIVING DONOR LIVER TRANSPLANT IN COMPARISON WITH CADAVERIC LIVER TRANSPLANT

AUTHORS: Mitsuru Nakatsuka, MD, Robert A. Fisher, MD, Marc P. Posner, MD, John M. Ham, MD, Amadeo Marcos, MD
AFFILIATION: Medical College of Virginia of VCU, Richmond, VA.

INTRODUCTION: The shortage of the availability of livers for transplantation has promoted some transplant centers to seek alternatives to conventional cadaveric liver transplantation. Initially, living donor liver transplant (LDLTx) was designed to meet the demand for pediatric populations. Recently, at the Medical College of Virginia of VCU Hospitals, living donor transplantation for adult recipients has been developed successfully using the right lobe of the donor's liver. This is an initial report of the outcome result of the living donor liver transplantation compared with the cadaveric liver transplantation.
METHODS: Recipients were listed following UNOS criteria for LDLTx. All donors had general anesthesia and thoracic epidurals for postoperative pain control. All recipients had general anesthesia with invasive monitors in the same manner. All donors underwent full evaluations including liver biopsy, MR, and angiography. A calculated donor right lobe mass to recipient body weight ratio (DRBWR) of 0.8 to 1% was the minimal acceptable value for living donation. The donor underwent right lobe hepatectomy aided by intraoperative cholangiography and ultrasonography. The right liver was weighed prior to liver transplantation. results were compared to a cohort of patients who underwent cadaveric donor liver transplantation (CDLTx) during the same period.
RESULTS: Thirty-four adults underwent liver transplant between June 1998 and January 1999. Sixteen were LDLTx (47%). Mean follow up was 105±67 days (7-217). Donors: Five of the 16 donor recipient pairs were unrelated. Mean body weight (BW) was 75±12.6 kg (60-109). Intraoperative blood loss was 680 ± 391 cc (230-1170). No bank blood was given. Operative time was 9.6±2.1 hours (6.5-12.1). Hospital stays were 5.2±2.3 days (3-10). Complications in 4 patients included intraoperative pressure scores (2), atelectasis (1), phlebitis (1), and groin seroma (1). None of the donors required readmission. Recipients: LDLTx group: 4 in UNOS status IIA, 10 in IIB, and 2 in III. Mean BW was 80±17.3 kg (53-115). DRBWR was 1.2±0.3% (0.9-2.6). Liver mass weight was 810±59 grams (690-1250). Hospital stay was 14.2±6.1 days (6-62). Complications included bilomas (7), sepsis (4), upper GI bleed (2), and seizure (1). There were no acute cellular rejections (ACR). 87% grafts and patients survived. Two deaths resulted from uncontrolled sepsis (Aspergillus [1], VRE [2]). All had functioning grafts at the time of death. CDLTx groups: 15 in UNOS status IIB and 3 in III. Hospital stay was 16.1 ± 9.7 days (5-60). 22% of ACR, 89% of graft survival.
CONCLUSIONS: The demand of cadaveric liver organs is increasing in spite of the declining number of donations in our center. RL hepatectomy can be performed with minimum morbidity to the donor and can provide sufficient live mass to the adult recipients. Postoperative course, ACR, and both graft and patient survival were not significantly different between LDLTx and CDLTx groups. LDLTx seems to be a reasonable alternative to CDLTx.