Outcomes of 385 adult-to-adult living donor liver transplant recipients

A report from the A2ALL consortium

Kim M. Olthoff, Robert M. Merion, Rafik M. Ghobrial, Michael M. Abecassis, Jeffrey Fair, Robert A. Fisher, Chris E. Freise, Igal Kam, Timothy L. Pruett, James E. Everhart, Tempie E. Hulbert-Shearon, Brenda W. Gillespie, Jean C. Emond, Charles M. Miller, Raymond Pollak, Charles B. Huddleston, Nancy L. Ascher, Byers W. Shaw, Robert M. Mentzer

Research output: Contribution to journalArticle

270 Citations (Scopus)

Abstract

Objective: The objective of this study was to characterize the patient population with respect to patient selection, assess surgical morbidity and graft failures, and analyze the contribution of perioperative clinical factors to recipient outcome in adult living donor liver transplantation (ALDLT). Summary Background Data: Previous reports have been center-specific or from large databases lacking detailed variables. The Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) represents the first detailed North American multicenter report of recipient risk and outcome aiming to characterize variables predictive of graft failure. Methods: Three hundred eighty-five ALDLT recipients transplanted at 9 centers were studied with analysis of over 35 donor, recipient, intraoperative, and postoperative variables. Cox regression models were used to examine the relationship of variables to the risk of graft failure. Results: Ninety-day and 1-year graft survival were 87% and 81%, respectively. Fifty-one (13.2%) grafts failed in the first 90 days. The most common causes of graft failure were vascular thrombosis, primary nonfunction, and sepsis. Biliary complications were common (30% early, 11% late). Older recipient age and length of cold ischemia were significant predictors of graft failure. Center experience greater than 20 ALDLT was associated with a significantly lower risk of graft failure. Recipient Model for End-stage Liver Disease score and graft size were not significant predictors. Conclusions: This multicenter A2ALL experience provides evidence that ALDLT is a viable option for liver replacement. Older recipient age and prolonged cold ischemia time increase the risk of graft failure. Outcomes improve with increasing center experience.

Original languageEnglish (US)
Pages (from-to)314-325
Number of pages12
JournalAnnals of Surgery
Volume242
Issue number3
DOIs
StatePublished - Sep 2005
Externally publishedYes

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Living Donors
Transplants
Liver
Liver Transplantation
Cold Ischemia
Transplant Recipients
End Stage Liver Disease
Graft Survival
Proportional Hazards Models
Patient Selection
Blood Vessels
Sepsis
Thrombosis
Cohort Studies
Tissue Donors
Databases
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Olthoff, K. M., Merion, R. M., Ghobrial, R. M., Abecassis, M. M., Fair, J., Fisher, R. A., ... Mentzer, R. M. (2005). Outcomes of 385 adult-to-adult living donor liver transplant recipients: A report from the A2ALL consortium. Annals of Surgery, 242(3), 314-325. https://doi.org/10.1097/01.sla.0000179646.37145.ef

Outcomes of 385 adult-to-adult living donor liver transplant recipients : A report from the A2ALL consortium. / Olthoff, Kim M.; Merion, Robert M.; Ghobrial, Rafik M.; Abecassis, Michael M.; Fair, Jeffrey; Fisher, Robert A.; Freise, Chris E.; Kam, Igal; Pruett, Timothy L.; Everhart, James E.; Hulbert-Shearon, Tempie E.; Gillespie, Brenda W.; Emond, Jean C.; Miller, Charles M.; Pollak, Raymond; Huddleston, Charles B.; Ascher, Nancy L.; Shaw, Byers W.; Mentzer, Robert M.

In: Annals of Surgery, Vol. 242, No. 3, 09.2005, p. 314-325.

Research output: Contribution to journalArticle

Olthoff, KM, Merion, RM, Ghobrial, RM, Abecassis, MM, Fair, J, Fisher, RA, Freise, CE, Kam, I, Pruett, TL, Everhart, JE, Hulbert-Shearon, TE, Gillespie, BW, Emond, JC, Miller, CM, Pollak, R, Huddleston, CB, Ascher, NL, Shaw, BW & Mentzer, RM 2005, 'Outcomes of 385 adult-to-adult living donor liver transplant recipients: A report from the A2ALL consortium', Annals of Surgery, vol. 242, no. 3, pp. 314-325. https://doi.org/10.1097/01.sla.0000179646.37145.ef
Olthoff, Kim M. ; Merion, Robert M. ; Ghobrial, Rafik M. ; Abecassis, Michael M. ; Fair, Jeffrey ; Fisher, Robert A. ; Freise, Chris E. ; Kam, Igal ; Pruett, Timothy L. ; Everhart, James E. ; Hulbert-Shearon, Tempie E. ; Gillespie, Brenda W. ; Emond, Jean C. ; Miller, Charles M. ; Pollak, Raymond ; Huddleston, Charles B. ; Ascher, Nancy L. ; Shaw, Byers W. ; Mentzer, Robert M. / Outcomes of 385 adult-to-adult living donor liver transplant recipients : A report from the A2ALL consortium. In: Annals of Surgery. 2005 ; Vol. 242, No. 3. pp. 314-325.
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abstract = "Objective: The objective of this study was to characterize the patient population with respect to patient selection, assess surgical morbidity and graft failures, and analyze the contribution of perioperative clinical factors to recipient outcome in adult living donor liver transplantation (ALDLT). Summary Background Data: Previous reports have been center-specific or from large databases lacking detailed variables. The Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) represents the first detailed North American multicenter report of recipient risk and outcome aiming to characterize variables predictive of graft failure. Methods: Three hundred eighty-five ALDLT recipients transplanted at 9 centers were studied with analysis of over 35 donor, recipient, intraoperative, and postoperative variables. Cox regression models were used to examine the relationship of variables to the risk of graft failure. Results: Ninety-day and 1-year graft survival were 87{\%} and 81{\%}, respectively. Fifty-one (13.2{\%}) grafts failed in the first 90 days. The most common causes of graft failure were vascular thrombosis, primary nonfunction, and sepsis. Biliary complications were common (30{\%} early, 11{\%} late). Older recipient age and length of cold ischemia were significant predictors of graft failure. Center experience greater than 20 ALDLT was associated with a significantly lower risk of graft failure. Recipient Model for End-stage Liver Disease score and graft size were not significant predictors. Conclusions: This multicenter A2ALL experience provides evidence that ALDLT is a viable option for liver replacement. Older recipient age and prolonged cold ischemia time increase the risk of graft failure. Outcomes improve with increasing center experience.",
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AU - Olthoff, Kim M.

AU - Merion, Robert M.

AU - Ghobrial, Rafik M.

AU - Abecassis, Michael M.

AU - Fair, Jeffrey

AU - Fisher, Robert A.

AU - Freise, Chris E.

AU - Kam, Igal

AU - Pruett, Timothy L.

AU - Everhart, James E.

AU - Hulbert-Shearon, Tempie E.

AU - Gillespie, Brenda W.

AU - Emond, Jean C.

AU - Miller, Charles M.

AU - Pollak, Raymond

AU - Huddleston, Charles B.

AU - Ascher, Nancy L.

AU - Shaw, Byers W.

AU - Mentzer, Robert M.

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N2 - Objective: The objective of this study was to characterize the patient population with respect to patient selection, assess surgical morbidity and graft failures, and analyze the contribution of perioperative clinical factors to recipient outcome in adult living donor liver transplantation (ALDLT). Summary Background Data: Previous reports have been center-specific or from large databases lacking detailed variables. The Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) represents the first detailed North American multicenter report of recipient risk and outcome aiming to characterize variables predictive of graft failure. Methods: Three hundred eighty-five ALDLT recipients transplanted at 9 centers were studied with analysis of over 35 donor, recipient, intraoperative, and postoperative variables. Cox regression models were used to examine the relationship of variables to the risk of graft failure. Results: Ninety-day and 1-year graft survival were 87% and 81%, respectively. Fifty-one (13.2%) grafts failed in the first 90 days. The most common causes of graft failure were vascular thrombosis, primary nonfunction, and sepsis. Biliary complications were common (30% early, 11% late). Older recipient age and length of cold ischemia were significant predictors of graft failure. Center experience greater than 20 ALDLT was associated with a significantly lower risk of graft failure. Recipient Model for End-stage Liver Disease score and graft size were not significant predictors. Conclusions: This multicenter A2ALL experience provides evidence that ALDLT is a viable option for liver replacement. Older recipient age and prolonged cold ischemia time increase the risk of graft failure. Outcomes improve with increasing center experience.

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