Post-Transplant Complications in Recipients of Deceased and Living Donor Liver Transplant.

Abstract

Purpose: To study long-term complications in recipients of deceased donor liver transplant (DDLT) and living donor liver transplant (LDLT) in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL). Methods: We analyzed 471 DDLT and 565 LDLT from 1998 to 2010 followed up to 10 years for 39 categories of complications graded by Clavien-Dindo classification. Kaplan-Meier was used to estimate probability of complication and resolution over time, and predictors of complications were tested in Cox models. Results: Recipients of LDLT were more likely to be white, have cholestatic liver disease. DDLT recipients were more likely to have HCC, be in the ICU, on a ventilator, or have ascites. 85% and 47% of LDLT and DDLT recipients had a physiologic MELD less than 21 at the time of the transplant. Median follow-up for DDLT and LDLT was 3.12 and 3.52 years, respectively. Complications more probable in LDLT included bile leak, biliary stricture, HAT and bacteremia. In DDLT, ascites, intra-abdominal bleeding, cardiac complications and recurrent cirrhosis were more probable.Figure: No Caption available.At least one complication occurred in 70% and 73% of DDLT and LDLT, respectively. A higher probability of grade 3 or 4 complications was observed in LDLT recipients (28 % vs. 20% at 8 years, p=0.03). We found that risk factors for Grade 4 complications were DCD, dialysis at transplant, ascites, and duration of operation, but no significant difference between DDLT and LDLT (HR=0.89, p=0.60). Development of chronic kidney disease was less likely in LDLT recipients (HR 0.41, p=0.02). 95% of complications resolved in 5 years, with 86% of complications resolving in 12 months and no statistical difference between DDLT and LDLT. Biliary strictures, hernia, vascular and psychological complications had the lowest probability of resolution within 12 months. Conclusions: Biliary and vascular complications remain a challenge in LDLT while renal impairment, cardiac complications and recurrent cirrhosis are more probable in DDLT.