CHOLESTASIS AFTER REDUCED LIVER TRANSPLANTATION. COMPARASION TO CADAVERIC LIVER TRANSPLANTATION.

Abstract

A156 Split and living donor liver transplantation in adults have emerged as good alternatives to the increasing donor shortage. In reduced liver transplantation, early cholestasis is a frequent clinical problem with confusing etiology and prognosis. Aim: The aim of this study was to compare the incidence of cholestasis in a series of reduced liver graft recipients with one of cadaveric whole liver transplant recipients. Material and Methods: From March 2000 to December 2003, 40 reduced liver transplants (RLT) with a mean graft to body weight ratio (GBWR) of 1.11±0.24 were performed in our Hospital. RLT was retrospectively compared with 80 cadaveric liver transplants (CLT) performed immediately before and after each RLT. Total bilirrubin (Bb), alkaline phosphatase (AP) and gammaGT(GGT) were mesured daily during the first week and three times a week until hospital discharge. Liver biopsy was performed when graft dysfunction occured. Cholestasis was defined as the presence of at least two of the following criteria, in the absence of acute liver rejection or hepatitis C virus recurrence: Bb > 3 mg/dl, or AP > 600 UI, or GGT > 300 UI. Results: No differences were found in either group regarding recipients’ age, sex, diagnosis and Child-Pough score, both groups were comparable except for cold ischemia time (91±45 min in CLT vs 353±131 min in RLT, p<0.05)) and donor age (33±8 years in RLT vs 45±10 years in CLT, p<0.05). During the follow-up, a significant higher biliary complication rate was found in the RLT group in comparison with CLT group (53.8% vs 12.9%, p<0.05). Incidence of cholestasis was higher in the RLT group when compared to the CLT group (48.5% vs 25.4%, p<0.05) Mean AP and GGT were significantly higher in the RLT group. (705±476 vs 483±304, p<0.05 and 470±376 vs 268±230, p<0.05). No difference in cholestasis was found when recipients of the RLT group were divided into two groups according to the presence or absence of biliary complications (46.7% vs 64.7%, p=ns). Furthermore, no correlation was found in the RLT group between cholestasis and GBWR, blood portal flow, cold ischemia time or Child-Pugh classification. Conclusion: Cholestasis is more frequent in recipients underwent reduced liver transplantation and this doesn’t seem to correlate with occurrence of biliary complications, more frequently found in these procedures.