DOES THE USE OF PARTIAL GRAFTS IN ADULT LIVER TRANSPLANTATION MODIFY EARLY PATIENT SURVIVAL?

Abstract

O167 The aim of this retrospective study was to analyse and compare patient and graft survival, early graft function and post-operative surgical complications in recipients according to the type of graft they received. Patients and methods: Since october 1990 to march 2003, 661 LT were performed in 640 patients (565 adults and 96 children) by using 493 whole livers (WL) and 168 (25.4%) partial liver grafts (PL). In adults, 462 had had a WL and 103 (18%) a PL. PL were obtained from split cadaveric grafts in 52 cases (44 right lobes and 8 left lobes) and living donors in 51 cases (47 right lobes and 4 left lobes). Statistical analysis : survivals were compared by using the Kaplan-Meier survival curves and the follow-up with Log-Rank tests. Results: The study period was divided in two parts according to the initiation of adult LT program with right liver lobe from living donor in december 1998. Between october 1990 and november 1998, among 313 LT performed in adult patients 293 were done by using a whole liver graft and 20 (6.4%) with a partial graft (16 right split grafts and 4 left liver grafts from living donor). One year survivals were 87.5%, 87.5% and 25% in patients with whole, right split and live donor left liver grafts respecctively. During the second period from december 1998 to march 2003, 251 adult patients had LT and among them, 83 (33%) received a partial liver graft (28 right and 8 left grafts from split livers and 47 right livers from living donors). Six out the 8 patients who received a left liver, had a meso-caval disconnection in the aim to decrease the portal inflow. In patients who received a PL, the cirrhosis was more advanced at the time of LT than in those who had a WL (patient Child C status : 54% vs 33.5%, p>0.05), moreover the rate of hepatocarcinoma was much higher (p>0.05) (figures 2 & 3). The rates of hepatic artery thrombosis and early retransplantation (within the first year) was similar in both groups (1.3% vs 1.6% and 2.9% vs 2.6% respectively). One year patient survival was 87% in patients with WL and 83.8% in those with PL (p=NS). According to the type of PL, patient survival was 88.5% in those who had a right liver lobe (n=91), 70% with a left lobe (n=12). Moreover, patients who received a right lobe from a living donor (n=47) and a left lobe from a split cadaveric graft (n=8) had a 1-year survival of 91.3% and 87% respectively. In 6 patients who had had a small-for-size left split liver lobe, a porto-mesenterical disconnection was performed through a mesocaval shunt to avoid an overperfusion syndrome. Conclusions: The early survival of adult patients receiving a partial liver graft was not affected in spite of their worse conditions and the more demanding techniques compared with those having a whole liver graft.