Ann Surg Treat Res.  2014 Jul;87(1):22-27. 10.4174/astr.2014.87.1.22.

Balanced approach can help initial outcomes: analysis of initial 50 cases of a new liver transplantation program in East Asia

• Kim DS
• Yu YD
• Jung SW
• Yang KS
• Seo YS
• Um SH
• Suh SO

• KMID: 1804095
• DOI: http://doi.org/10.4174/astr.2014.87.1.22

Abstract

PURPOSE
To evaluate patient triage pattern and outcomes according to types of liver transplantation as part of a new liver transplant program developed in an East Asian country with a limited number of deceased donors.
METHODS
Medical records of initial 50 liver transplantations were reviewed retrospectively.
RESULTS
Twenty-nine patients underwent deceased donor liver transplantation (DDLT) and 21 patients underwent living donor liver transplantation (LDLT). Mean model for end-stage liver disease scores of recipients of DDLT and LDLT were 24.9 +/- 11.6 and 13.1 +/- 5.4, respectively (P < 0.0001). Twenty-eight patients had HCCs and 17 of them (60.7%) underwent LDLT, which was 80.9% of LDLTs. There were 2 cases of perioperative mortality; each was from DDLT and LDLT, respectively. Median follow-up was 18 months. Overall patient and graft survival rates at 6 months, 1 and 2 years were 95.7%, 93.4%, and 89.8%, respectively. There was no significant difference in survival between DDLT and LDLT. Overall recurrence-free survival rates of hepatocellular carcinoma (HCC) patients at 6 month, 1, and 2 years were 96.3%, 96.3%, and 90.3%, respectively. There was no significant difference in recurrence-free survival between DDLT and LDLT.
CONCLUSION
As a new liver transplant program with limited resource and waiting list, patients with critical condition could undergo DDLT whereas relatively stable patients with HCCs were mostly directed to LDLT. We recommend a balanced approach between DDLT and LDLT for initiating liver transplant programs.

Keyword

Liver transplantation; Donor selection; Liver transplantation program; Outcome; Survival

MeSH Terms

Asian Continental Ancestry Group
Carcinoma, Hepatocellular
Donor Selection
Far East*
Follow-Up Studies
Graft Survival
Humans
Liver
Liver Diseases
Liver Transplantation*
Living Donors
Medical Records
Mortality
Retrospective Studies
Survival Rate
Tissue Donors
Triage
Waiting Lists

Figure

• 

  Fig. 1 Kaplan-Meier analysis of overall patient survival (A), survival after deceased donor liver transplantation and living donor liver transplantation (B), and recurrence-free survival of patients with hepatocellular carcinoma (C). DDLT, deceased donor liver transplantation; LDLT, living donor liver transplantation.

• 

  Fig. 2 Proportion of deceased donor liver transplantation (DDLT) compared to total number of liver transplantation in each center in Korea. Y axis represents percentage of DDLT. X axis represents individual centers sorted by the number of liver transplantation performed during last 5 years (2009-2013). Center 1 depicts the center where the largest number of liver transplantation was performed. Centers are divided into 3 groups: centers in group 1 (white zone, center 1-9) performed more than 100 cases, centers in group 2 (light gray zone, center 10-20) performed between 20-100 cases, and center in group 3 (dark gray zone, center 21-42) performed less than 20 cases over last 5 years.

Reference

1. Starzl TE, Groth CG, Brettschneider L, Penn I, Fulginiti VA, Moon JB, et al. Orthotopic homotransplantation of the human liver. Ann Surg. 1968; 168:392–415.

2. Olthoff KM, Merion RM, Ghobrial RM, Abecassis MM, Fair JH, Fisher RA, et al. Outcomes of 385 adult-to-adult living donor liver transplant recipients: a report from the A2ALL Consortium. Ann Surg. 2005; 242:314–323.

3. Korean Network of Organ Sharing, Annual report of the transplant 2012. Seoul: Korean Network of Organ Sharing;2013.

4. Korean Network for Organ Sharing. Statistics of organ donation and transplantation [Internet]. Seoul: Korean Network for Organ Sharing;cited 2014 Jan 14. Available from: http://www.konos.go.kr.

5. Durand F, Renz JF, Alkofer B, Burra P, Clavien PA, Porte RJ, et al. Report of the Paris consensus meeting on expanded criteria donors in liver transplantation. Liver Transpl. 2008; 14:1694–1707.

6. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996; 334:693–699.

7. Lee SG, Park KM, Hwang S, Kim KH, Choi DN, Joo SH, et al. Modified right liver graft from a living donor to prevent congestion. Transplantation. 2002; 74:54–59.

8. Lo CM, Fan ST, Liu CL, Wei WI, Lo RJ, Lai CL, et al. Adult-to-adult living donor liver transplantation using extended right lobe grafts. Ann Surg. 1997; 226:261–269.

9. Wojcicki M, Lubikowski J, Czuprynska M, Jarosz K, Sluzar T, Zeair S, et al. Early results of a new liver transplant program in Szczecin, Poland. Ann Transplant. 2003; 8:50–56.

10. Lee EK, Chang SH, Kim DK, Cheon BS, Hong YS, Kang BJ, et al. Outcomes of early liver transplantation in a hospital that is starting to perform liver transplantation. J Korean Soc Transplant. 2011; 25:184–189.

11. Kim JD, Choi DL, Han YS. An early single-center experience of portal vein thrombosis in living donor liver transplantation: clinical feature, management and outcome. J Korean Surg Soc. 2011; 81:35–42.

12. Berg CL, Gillespie BW, Merion RM, Brown RS Jr, Abecassis MM, Trotter JF, et al. Improvement in survival associated with adult-to-adult living donor liver transplantation. Gastroenterology. 2007; 133:1806–1813.

13. Liu CL, Fan ST, Lo CM, Wei WI, Chan SC, Yong BH, et al. Operative outcomes of adult-to-adult right lobe live donor liver transplantation: a comparative study with cadaveric whole-graft liver transplantation in a single center. Ann Surg. 2006; 243:404–410.

14. Li C, Wen TF, Yan LN, Li B, Yang JY, Wang WT, et al. Outcome of hepatocellular carcinoma treated by liver transplantation: comparison of living donor and deceased donor transplantation. Hepatobiliary Pancreat Dis Int. 2010; 9:366–369.

15. Jeon H, Lee SG. Living donor liver transplantation. Curr Opin Organ Transplant. 2010; 15:283–287.

16. Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001; 33:1394–1403.