Analysis of failure in living donor liver transplantation

Differential outcomes in children and adults

Michael J. Goldstein, Ephrem Salame, Sandip Kapur, Milan Kinkhabwala, Diane LaPointe-Rudow, Patricia Harren, Steven J. Lobritto, Mark Russo, Robert S. Brown, Guellue Cataldegirmen, Alan Weinberg, John F. Renz, Jean C. Emond

Research output: Contribution to journalArticle

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Abstract

Over the past decade we have reported excellent outcomes in pediatric living-donor liver transplantation (LDLT) with recipient survival exceeding 90%. Principles established in these patients were extended to LDLT in adults. To compare outcomes in donors and recipients between adult and pediatric LDLT in a single center, we reviewed patient records of 45 LDLT performed between 1/98 and 2/01: 23 adult LDLT (54 ± 6.5 yr) and 22 pediatric LDLT (33.7 ± 53.5 months). Preoperative liver function was worse in adults (International Normalized Ratio [INR] 1.5 ± 0.4 vs. INR 1.2 ± 0.5; p = 0.032). 4 adults (17%) met criteria for status 1 or 2A. Only 1 child was transplanted urgently. Analysis included descriptive statistics and Kaplan-Meier estimation. Donor mortality was 0% with 1 reexploration, 2.4%. Median hospital stay (LOS) was 6.0 days (range, 4-12 days). Donor morbidity and LOS did not differ by sex, extent of hepatectomy, or adult and pediatric LDLT (p = 0.49). In contrast, recipient outcomes were worse for adults. Adult 1 year graft survival was 65% (3 retransplants [ReTx], 5 deaths) vs. 91% for children (1 ReTx, 1 death) p = 0.02. Graft losses in adults were due to sepsis (n = 3), small for size (n = 2), suicide, and hepatic artery thrombosis (HAT), whereas in children graft losses were due to portal thrombosis and total parenteral nutrition (TPN) liver failure. Biliary leaks occurred in 22% of adults and 9% of children. Hepatic vein obstruction occurred in 17% of adults and in none of the children. Median LOS was comparable (adult, 16.5 days (range, 7-149 days); child, 17 days (range, 10-56 days),p = 0.2). Graft function (total bilirubin (TBili) < 5mg/dl, INR < 1.2, aspartate aminotransferase (AST) < 100 U/l) normalizing by day 4 in children and by day 14 in adults. Adults fared worse, with an array of problems not seen in children, in particular, hepatic vein obstruction and small-for-size syndrome. Biliary leaks were diagnosed later in adults and were lethal in 3 cases; this was later avoided with biliary drainage in adult recipients. Finally, use of LDLT in decompensated adults led to death in 3 of 4 patients, and should be restricted to elective use.

Original languageEnglish (US)
Pages (from-to)356-364
Number of pages9
JournalWorld Journal of Surgery
Volume27
Issue number3
DOIs
StatePublished - Mar 2003
Externally publishedYes

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Living Donors
Liver Transplantation
International Normalized Ratio
Pediatrics
Hepatic Veins
Tissue Donors
Transplants
Thrombosis
Total Parenteral Nutrition
Hepatic Artery
Liver Failure
Hepatectomy
Graft Survival
Aspartate Aminotransferases
Bilirubin
Suicide
Drainage
Length of Stay
Sepsis
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Analysis of failure in living donor liver transplantation : Differential outcomes in children and adults. / Goldstein, Michael J.; Salame, Ephrem; Kapur, Sandip; Kinkhabwala, Milan; LaPointe-Rudow, Diane; Harren, Patricia; Lobritto, Steven J.; Russo, Mark; Brown, Robert S.; Cataldegirmen, Guellue; Weinberg, Alan; Renz, John F.; Emond, Jean C.

In: World Journal of Surgery, Vol. 27, No. 3, 03.2003, p. 356-364.

Research output: Contribution to journalArticle

Goldstein, MJ, Salame, E, Kapur, S, Kinkhabwala, M, LaPointe-Rudow, D, Harren, P, Lobritto, SJ, Russo, M, Brown, RS, Cataldegirmen, G, Weinberg, A, Renz, JF & Emond, JC 2003, 'Analysis of failure in living donor liver transplantation: Differential outcomes in children and adults', World Journal of Surgery, vol. 27, no. 3, pp. 356-364. https://doi.org/10.1007/s00268-002-6598-8
Goldstein, Michael J. ; Salame, Ephrem ; Kapur, Sandip ; Kinkhabwala, Milan ; LaPointe-Rudow, Diane ; Harren, Patricia ; Lobritto, Steven J. ; Russo, Mark ; Brown, Robert S. ; Cataldegirmen, Guellue ; Weinberg, Alan ; Renz, John F. ; Emond, Jean C. / Analysis of failure in living donor liver transplantation : Differential outcomes in children and adults. In: World Journal of Surgery. 2003 ; Vol. 27, No. 3. pp. 356-364.
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abstract = "Over the past decade we have reported excellent outcomes in pediatric living-donor liver transplantation (LDLT) with recipient survival exceeding 90{\%}. Principles established in these patients were extended to LDLT in adults. To compare outcomes in donors and recipients between adult and pediatric LDLT in a single center, we reviewed patient records of 45 LDLT performed between 1/98 and 2/01: 23 adult LDLT (54 ± 6.5 yr) and 22 pediatric LDLT (33.7 ± 53.5 months). Preoperative liver function was worse in adults (International Normalized Ratio [INR] 1.5 ± 0.4 vs. INR 1.2 ± 0.5; p = 0.032). 4 adults (17{\%}) met criteria for status 1 or 2A. Only 1 child was transplanted urgently. Analysis included descriptive statistics and Kaplan-Meier estimation. Donor mortality was 0{\%} with 1 reexploration, 2.4{\%}. Median hospital stay (LOS) was 6.0 days (range, 4-12 days). Donor morbidity and LOS did not differ by sex, extent of hepatectomy, or adult and pediatric LDLT (p = 0.49). In contrast, recipient outcomes were worse for adults. Adult 1 year graft survival was 65{\%} (3 retransplants [ReTx], 5 deaths) vs. 91{\%} for children (1 ReTx, 1 death) p = 0.02. Graft losses in adults were due to sepsis (n = 3), small for size (n = 2), suicide, and hepatic artery thrombosis (HAT), whereas in children graft losses were due to portal thrombosis and total parenteral nutrition (TPN) liver failure. Biliary leaks occurred in 22{\%} of adults and 9{\%} of children. Hepatic vein obstruction occurred in 17{\%} of adults and in none of the children. Median LOS was comparable (adult, 16.5 days (range, 7-149 days); child, 17 days (range, 10-56 days),p = 0.2). Graft function (total bilirubin (TBili) < 5mg/dl, INR < 1.2, aspartate aminotransferase (AST) < 100 U/l) normalizing by day 4 in children and by day 14 in adults. Adults fared worse, with an array of problems not seen in children, in particular, hepatic vein obstruction and small-for-size syndrome. Biliary leaks were diagnosed later in adults and were lethal in 3 cases; this was later avoided with biliary drainage in adult recipients. Finally, use of LDLT in decompensated adults led to death in 3 of 4 patients, and should be restricted to elective use.",
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AU - Harren, Patricia

AU - Lobritto, Steven J.

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AU - Brown, Robert S.

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N2 - Over the past decade we have reported excellent outcomes in pediatric living-donor liver transplantation (LDLT) with recipient survival exceeding 90%. Principles established in these patients were extended to LDLT in adults. To compare outcomes in donors and recipients between adult and pediatric LDLT in a single center, we reviewed patient records of 45 LDLT performed between 1/98 and 2/01: 23 adult LDLT (54 ± 6.5 yr) and 22 pediatric LDLT (33.7 ± 53.5 months). Preoperative liver function was worse in adults (International Normalized Ratio [INR] 1.5 ± 0.4 vs. INR 1.2 ± 0.5; p = 0.032). 4 adults (17%) met criteria for status 1 or 2A. Only 1 child was transplanted urgently. Analysis included descriptive statistics and Kaplan-Meier estimation. Donor mortality was 0% with 1 reexploration, 2.4%. Median hospital stay (LOS) was 6.0 days (range, 4-12 days). Donor morbidity and LOS did not differ by sex, extent of hepatectomy, or adult and pediatric LDLT (p = 0.49). In contrast, recipient outcomes were worse for adults. Adult 1 year graft survival was 65% (3 retransplants [ReTx], 5 deaths) vs. 91% for children (1 ReTx, 1 death) p = 0.02. Graft losses in adults were due to sepsis (n = 3), small for size (n = 2), suicide, and hepatic artery thrombosis (HAT), whereas in children graft losses were due to portal thrombosis and total parenteral nutrition (TPN) liver failure. Biliary leaks occurred in 22% of adults and 9% of children. Hepatic vein obstruction occurred in 17% of adults and in none of the children. Median LOS was comparable (adult, 16.5 days (range, 7-149 days); child, 17 days (range, 10-56 days),p = 0.2). Graft function (total bilirubin (TBili) < 5mg/dl, INR < 1.2, aspartate aminotransferase (AST) < 100 U/l) normalizing by day 4 in children and by day 14 in adults. Adults fared worse, with an array of problems not seen in children, in particular, hepatic vein obstruction and small-for-size syndrome. Biliary leaks were diagnosed later in adults and were lethal in 3 cases; this was later avoided with biliary drainage in adult recipients. Finally, use of LDLT in decompensated adults led to death in 3 of 4 patients, and should be restricted to elective use.

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