Abstract
O300 Aims: Current data suggest that right lobe live donor liver transplantation (RLDLT) has an inferior graft survival outcome when compared with cadaveric whole-graft liver transplantation (CWLT). Detailed comparison of the operative outcomes between these two groups of patients in a single center has not been reported. The aim of the present study was to evaluate the operative and survival outcomes of patients who underwent RLDLT and to compare the results with those of CWLT recipients in a single institution. Methods: A prospective study was performed on 180 consecutive adult patients who underwent primary liver transplantation from January 2000 to February 2004. They were given the options of LDLT and CWLT after being listed for transplantation. Detailed counseling was provided to patients and their relatives who opted for RLDLT. The middle hepatic vein was included in the graft in all except one patient. The operative and survival outcomes of 124 patients undergoing RLDLT were compared with those of 56 CWLT recipients during the same study period. Results: Fifty-eight (47%) patients were on high-urgency list and 23 (19%) of them were on life-support before operation in the RLDLT group. The corresponding figures in the CWLT group were 17 (30%) and 5 (9%). The preoperative Model for End-stage Liver Disease scores in patients with chronic liver diseases were comparable in both groups (median, 21 vs. 19, p = 0.396). The waiting time for liver transplantation was significantly shorter in the RLDLT group (median, 13.5 vs. 237 days, p <0.001). The graft weight to estimated standard liver weight ratio was lower in the RLDLT group (median, 0.489 vs. 0.982, p <0.001). The cold ischemic time of liver graft was much shorter (median, 113 vs. 362 minutes, p < 0.001), but the time required for graft implantation was longer in the RLDLT group (median, 273 vs. 244 minutes, p = 0.017). Twenty-two (18%) patients in the RLDLT group and 9 (16%) patients in the CWLT group did not require blood transfusion. The postoperative hospital stay was comparable (median, 19 vs. 17 days). The hospital mortality rate in the RLDLT group was 1.6%, and was not different from that in the CWLT group (5.4%). Hospital mortality did not occur in the last 105 consecutive patients in the RLDLT group. There was no donor mortality. Thirty-one (25%) patients in the RLDLT group developed biliary stricture on follow-up, while 3 (5%) patients in the CWLT group developed the complication (p = 0.002). At a median follow-up of 22 months, the actuarial graft and patient survival rates were 89% and 90%, respectively, in the RLDLT group, and both were 88% in the CWLT group. Conclusions: Despite a more complex operation and smaller graft volume, RLDLT results in favorable operative outcomes comparable to those of CWLT. However, there is a significantly higher incidence of biliary stricture associated with RLDLT. Further refinement in biliary reconstruction technique is required before RLDLT becomes a standard operation.
Published Version
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