2500 Cases of Adult Living Donor Liver Transplantations in Single Institution

Abstract

Background: Although there has been continuing concern about donor safety, living donor liver transplantation (LDLT) has been settled as feasible therapeutic option for end-stage liver disease. In this study, we introduce fifteen-year experience in adult living donor liver transplantation and present evolving steps in technical advancement in donor and recipient surgery. And we analyzed survival results and the risk factors affecting short-term and long term outcome of recipient. Method: We analyzed the data of 2500 adult LDLTs which have been performed from February 1997 to August 2011, retrospectively. Result: We started adult LDLT program from February 1997 with left lobe LDLT. The mean age of recipient was 49.6±8.8 (18˜76) years. The sex ratio was 1870 (74.8%)/630 (Male/Female). The most common cause of LDLT was HBV-LC (74.6%). Total 1103 (44.1%) were accompanied by HCC. The mean MELD score was 20.1±10.4 (3˜40). The most commonly used graft type was modified right lobe graft (73.6%). The mean GRWR 1.06±0.21 (0.49˜2.43)%. The overall in-hospital mortality (IHM) was 5.6%. The IHM in early experience was significantly higher (33.3%) but has been lowered to around 5% recently by the refinement of surgical techniques and advancement of postoperative care. The 1-, 3-, 5-year patient survival rate was 90.4, 84.2 and 78.7%, respectively which was significantly higher than that of deceased donor liver transplantation during same period. When we analyzed risk factors affecting recipient outcome, preoperative recipient condition (MELD>30, recipient age >60, preoperative ventilator support or renal replacement therapy), GRWR (< 0.7%) and donor age (>50 years) were significant risk factors. The most common postoperative complication during immediate postoperative period (< 1month) was postoperative bleeding but overall most common complication was biliary stricture (13.2%). The most common cause of early death (< 3 month) was septic complication and that of late death was HCC recurrence. During this period, total 321 dual graft LDLT were performed. Therefore, 2819 living donors excluding 2 deceased donors were involved. The mean age of donor was 27.8±8.1 (16˜57). There was no donor mortality. The incidence of donor morbidity was higher (8.1%) during early experience and significantly higher in right lobe donor (10.7%) than left lobe donor (2.6%). But, it has been decreased to around 1% and no difference in graft type. Conclusion: Adult LDLT is most useful and effective therapeutic option for end-stage liver disease in the country with scarcity of deceased donor. However, the special concern should be paid for the safety of donor. We should improve recipient outcome by continuing refinement of surgical techniques and postoperative care to justify the inevitable donor risk.