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Left-liver Adult-to-Adult Living Donor Liver Transplantation Can It Be Improved? A Retrospective Multicenter European Study

(2018) ANNALS OF SURGERY. 268(5). p.876-884
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Abstract
Objective: To evaluate the European experience after Adult-to-adult living donor liver transplantation using the left liver (LL-aLDLT). Summary Background Data: LL-aLDLT decreases donor risk but provides a smaller graft that increases recipient risk as compared with right liver (RL-aLDLT). However, there is little knowledge of results obtained after LL-aLDLT in Europe. Methods: This is a European multicenter retrospective study which aims to analyze donor and recipient outcomes after 46 LL-aLDLT. Results: Seventy-six percent of the grafts were harvested by minimally invasive approach. Mean donor hospital stay was 7.5 +/- 3.5 days. Donor liver function was minimally impaired, with 36 donors (78.3%) without any 90-day complication, and 4 (8.7%) presenting major complications. One, 3, and 5-year recipient survival was 90.9%, 82.7%, and 82.7%, respectively. However, graft survival was of 59.4%, 56.9%, and 56.9% at 1, 3, and 5 years respectively, due to a 26.1% urgent liver retransplantation (ReLT) rate, mainly due to SFSS (n = 5) and hepatic artery thrombosis (HAT, n = 5). Risk factor analysis for ReLT and HAT showed an association with a graft to body weight ratio (GBWR) < 0.6% (P = 0.01 and P = 0.024, respectively) while SFSS was associated with a recipient MELD >= 14 (P = 0.019). A combination of donor age < 45 years, MELD < 14 and actual GBWR >0.6% was associated with a lower ReLT rate (0% vs. 33%, P = 0.044). Conclusions: Our analysis showed low donor morbidity and preserved liver function. Recipient outcomes, however, were hampered by a high ReLT rate. A strict selection of both donor and recipients is the key to minimize graft loss.

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Chicago
Sanchez-Cabus, Santiago, Daniel Cherqui, Niki Rashidian, Gabriella Pittau, Laure Elkrief, Aude Vanlander, Christian Toso, et al. 2018. “Left-liver Adult-to-Adult Living Donor Liver Transplantation Can It Be Improved? A Retrospective Multicenter European Study.” Annals of Surgery 268 (5): 876–884.
APA
Sanchez-Cabus, S., Cherqui, D., Rashidian, N., Pittau, G., Elkrief, L., Vanlander, A., Toso, C., et al. (2018). Left-liver Adult-to-Adult Living Donor Liver Transplantation Can It Be Improved? A Retrospective Multicenter European Study. ANNALS OF SURGERY, 268(5), 876–884.
Vancouver
1.
Sanchez-Cabus S, Cherqui D, Rashidian N, Pittau G, Elkrief L, Vanlander A, et al. Left-liver Adult-to-Adult Living Donor Liver Transplantation Can It Be Improved? A Retrospective Multicenter European Study. ANNALS OF SURGERY. 2018;268(5):876–84.
MLA
Sanchez-Cabus, Santiago et al. “Left-liver Adult-to-Adult Living Donor Liver Transplantation Can It Be Improved? A Retrospective Multicenter European Study.” ANNALS OF SURGERY 268.5 (2018): 876–884. Print.
@article{8600900,
  abstract     = {Objective: To evaluate the European experience after Adult-to-adult living donor liver transplantation using the left liver (LL-aLDLT). Summary Background Data: LL-aLDLT decreases donor risk but provides a smaller graft that increases recipient risk as compared with right liver (RL-aLDLT). However, there is little knowledge of results obtained after LL-aLDLT in Europe. Methods: This is a European multicenter retrospective study which aims to analyze donor and recipient outcomes after 46 LL-aLDLT. Results: Seventy-six percent of the grafts were harvested by minimally invasive approach. Mean donor hospital stay was 7.5 +/- 3.5 days. Donor liver function was minimally impaired, with 36 donors (78.3\%) without any 90-day complication, and 4 (8.7\%) presenting major complications. One, 3, and 5-year recipient survival was 90.9\%, 82.7\%, and 82.7\%, respectively. However, graft survival was of 59.4\%, 56.9\%, and 56.9\% at 1, 3, and 5 years respectively, due to a 26.1\% urgent liver retransplantation (ReLT) rate, mainly due to SFSS (n = 5) and hepatic artery thrombosis (HAT, n = 5). Risk factor analysis for ReLT and HAT showed an association with a graft to body weight ratio (GBWR) {\textlangle} 0.6\% (P = 0.01 and P = 0.024, respectively) while SFSS was associated with a recipient MELD {\textrangle}= 14 (P = 0.019). A combination of donor age {\textlangle} 45 years, MELD {\textlangle} 14 and actual GBWR {\textrangle}0.6\% was associated with a lower ReLT rate (0\% vs. 33\%, P = 0.044). Conclusions: Our analysis showed low donor morbidity and preserved liver function. Recipient outcomes, however, were hampered by a high ReLT rate. A strict selection of both donor and recipients is the key to minimize graft loss.},
  author       = {Sanchez-Cabus, Santiago and Cherqui, Daniel and Rashidian, Niki and Pittau, Gabriella and Elkrief, Laure and Vanlander, Aude and Toso, Christian and Fondevila, Constantino and Cunha, Antonio Sa and Berney, Thierry and Castaing, Denis and de Hemptinne, Bernard and Fuster, Josep and Rogiers, Xavier and Adam, Rene and Majno, Pietro and Carlos Garcia-Valdecasas, Juan and Troisi, Roberto},
  issn         = {0003-4932},
  journal      = {ANNALS OF SURGERY},
  number       = {5},
  pages        = {876--884},
  title        = {Left-liver Adult-to-Adult Living Donor Liver Transplantation Can It Be Improved? A Retrospective Multicenter European Study},
  url          = {http://dx.doi.org/10.1097/SLA.0000000000002897},
  volume       = {268},
  year         = {2018},
}

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