Recipient morbidity after living and deceased donor liver transplantation

Findings from the A2ALL retrospective cohort study

C. E. Freise, B. W. Gillespie, A. J. Koffron, A. S F Lok, T. L. Pruett, J. C. Emond, Jeffrey Fair, R. A. Fisher, K. M. Olthoff, J. F. Trotter, R. M. Ghobrial, J. E. Everhart

Research output: Contribution to journalArticle

174 Citations (Scopus)

Abstract

Patients considering living donor liver transplantation (LDLT) need to know the risk and severity of complications compared to deceased donor liver transplantation (DDLT). One aim of the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) was to examine recipient complications following these procedures. Medical records of DDLT or LDLT recipients who had a living donor evaluated at the nine A2ALL centers between 1998 and 2003 were reviewed. Among 384 LDLT and 216 DDLT, at least one complication occurred after 82.8% of LDLT and 78.2% of DDLT (p = 0.17). There was a median of two complications after DDLT and three after LDLT. Complications that occurred at a higher rate (p <0.05) after LDLT included biliary leak (31.8% vs. 10.2%), unplanned reexploration (26.2% vs. 17.1%), hepatic artery thrombosis (6.5% vs. 2.3%) and portal vein thrombosis (2.9% vs. 0.0%). There were more complications leading to retransplantation or death (Clavien grade 4) after LDLT versus DDLT (15.9% vs. 9.3%, p = 0.023). Many complications occurred more commonly during early center experience; the odds of grade 4 complications were more than two-fold higher when centers had performed ≤20 LDLT (vs. >40). In summary, complication rates were higher after LDLT versus DDLT, but declined with center experience to levels comparable to DDLT.

Original languageEnglish (US)
Pages (from-to)2569-2579
Number of pages11
JournalAmerican Journal of Transplantation
Volume8
Issue number12
DOIs
StatePublished - Dec 2008
Externally publishedYes

Fingerprint

Living Donors
Liver Transplantation
Cohort Studies
Retrospective Studies
Morbidity
Tissue Donors
Medical Records

Keywords

  • A2ALL
  • Complications
  • Learning curve
  • Liver transplant
  • Living donor
  • Outcomes

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Freise, C. E., Gillespie, B. W., Koffron, A. J., Lok, A. S. F., Pruett, T. L., Emond, J. C., ... Everhart, J. E. (2008). Recipient morbidity after living and deceased donor liver transplantation: Findings from the A2ALL retrospective cohort study. American Journal of Transplantation, 8(12), 2569-2579. https://doi.org/10.1111/j.1600-6143.2008.02440.x

Recipient morbidity after living and deceased donor liver transplantation : Findings from the A2ALL retrospective cohort study. / Freise, C. E.; Gillespie, B. W.; Koffron, A. J.; Lok, A. S F; Pruett, T. L.; Emond, J. C.; Fair, Jeffrey; Fisher, R. A.; Olthoff, K. M.; Trotter, J. F.; Ghobrial, R. M.; Everhart, J. E.

In: American Journal of Transplantation, Vol. 8, No. 12, 12.2008, p. 2569-2579.

Research output: Contribution to journalArticle

Freise, CE, Gillespie, BW, Koffron, AJ, Lok, ASF, Pruett, TL, Emond, JC, Fair, J, Fisher, RA, Olthoff, KM, Trotter, JF, Ghobrial, RM & Everhart, JE 2008, 'Recipient morbidity after living and deceased donor liver transplantation: Findings from the A2ALL retrospective cohort study', American Journal of Transplantation, vol. 8, no. 12, pp. 2569-2579. https://doi.org/10.1111/j.1600-6143.2008.02440.x
Freise, C. E. ; Gillespie, B. W. ; Koffron, A. J. ; Lok, A. S F ; Pruett, T. L. ; Emond, J. C. ; Fair, Jeffrey ; Fisher, R. A. ; Olthoff, K. M. ; Trotter, J. F. ; Ghobrial, R. M. ; Everhart, J. E. / Recipient morbidity after living and deceased donor liver transplantation : Findings from the A2ALL retrospective cohort study. In: American Journal of Transplantation. 2008 ; Vol. 8, No. 12. pp. 2569-2579.
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abstract = "Patients considering living donor liver transplantation (LDLT) need to know the risk and severity of complications compared to deceased donor liver transplantation (DDLT). One aim of the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) was to examine recipient complications following these procedures. Medical records of DDLT or LDLT recipients who had a living donor evaluated at the nine A2ALL centers between 1998 and 2003 were reviewed. Among 384 LDLT and 216 DDLT, at least one complication occurred after 82.8{\%} of LDLT and 78.2{\%} of DDLT (p = 0.17). There was a median of two complications after DDLT and three after LDLT. Complications that occurred at a higher rate (p <0.05) after LDLT included biliary leak (31.8{\%} vs. 10.2{\%}), unplanned reexploration (26.2{\%} vs. 17.1{\%}), hepatic artery thrombosis (6.5{\%} vs. 2.3{\%}) and portal vein thrombosis (2.9{\%} vs. 0.0{\%}). There were more complications leading to retransplantation or death (Clavien grade 4) after LDLT versus DDLT (15.9{\%} vs. 9.3{\%}, p = 0.023). Many complications occurred more commonly during early center experience; the odds of grade 4 complications were more than two-fold higher when centers had performed ≤20 LDLT (vs. >40). In summary, complication rates were higher after LDLT versus DDLT, but declined with center experience to levels comparable to DDLT.",
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AU - Fair, Jeffrey

AU - Fisher, R. A.

AU - Olthoff, K. M.

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