Cases Of Living Donor Liver Transplantation Research Articles

Metallic Stents for Hepatic Venous Outflow Obstruction After Living-Donor Liver Transplantation and their Therapeutic Effects

Living-donor liver transplantation (LDLT) is established as a standard therapy for end-stage liver disease; however, vessel reconstruction is more demanding due to the short length and small size of the available structures compared with deceased-donor whole liver transplantation. Interventional radiology (IR) has become the first-line treatment for vascular complications after LDLT. Hepatic venous outflow obstruction (HVOO) is a life-threatening complication after LDLT. The aim of this study of 592 adult-to-adult LDLT cases was to investigate the safety and efficacy of stent implantation for HVOO after LDLT. Records of patients who developed HVOO requiring any treatment were collected with special reference to the metallic stent implantation. There were 232 left-side grafts and 360 right-side grafts. Sixteen cases developed HVOO after LDLT with an incidence rate of 2.7%, 5 with a left liver graft (2%), and 11 with a right-side graft (3%). The IR was attempted for 14 cases; among those, 8 cases were treated by stent implantation. The technical success rate of the initial stent implantation was 100%. The pressure gradient at the stenotic site significantly improved from 12.2 (range, 10.9-20.4 cm H2O) to 3.9 cm H2O (range, 1.4-8.2 cm H2O; P=.03). The volume of the congested graft liver decreased significantly from 1448 (range, 788-2170 mL) to 1265 mL (range, 748-1665 mL; P=.01), and the serum albumin level improved significantly from 3.3 (range, 1.7-3.7 g/dL) to 3.7 g/dL (range, 2.9-4.1 g/dL; P=.02). No procedure-related complication was noted, and the long-term stent patency was 100%. Metallic stent implantation for stenotic venous anastomosis after LDLT is a safe and effective treatment.

Outcomes of living donor liver transplant recipients receiving grafts with the Graft-to-Recipient weight ratio less than 0.6%: A matched pair analysis.

We sometimes experience living donor liver transplantation (LDLT) involving very small grafts with graft-to-recipient weight ratio (GRWR) <0.6% when the actual graft size is smaller than predicted. The outcomes in this situation have not been fully investigated. The present study aimed to determine the graft outcomes of LDLT with GRWR <0.6%. We retrospectively reviewed 280 cases of adult LDLT performed at our institution between January 2000 and March 2021. In our institution, the lower limit for graft volume/standard liver volume ratio was 30%. The patients were divided into two groups according to the cutoff value of 0.6% for actual GRWR. Graft survival and surgical outcomes including small-for-size syndrome (SFSS) were compared between the groups using propensity score matching (PSM) analysis. Risk factors associated with SFSS in recipients with GRWR <0.6% were also evaluated. Fifty-nine patients received grafts with GRWR <0.6%. After PSM, similar graft survival rates were observed for GRWR <0.6% (n=53) and GRWR ≥0.6% (n=53) (p=0.98). However, patients with GRWR <0.6% had a significantly worse 3-month graft survival rate (86.8% vs. 98.1%, p=0.03) and higher incidence of SFSS (p<0.001) than patients with GRWR ≥0.6%. On multivariate analysis, Model for End-Stage Liver Disease score and donor age were associated with SFSS in patients with GRWR <0.6%. The same factors were also associated with graft survival. In conclusions, although similar overall graft survival rates were observed for LDLT with GRWR <0.6% and GRWR ≥0.6%, GRWR <0.6% was associated with an increased risk of SFSS. Appropriate donor and recipient selection is important for successful LDLT with very small grafts.

Pretransplant Renal Dysfunction Negatively Affects Prognosis After Living Donor Liver Transplantation: A Single-Center Retrospective Study

To evaluate the influence of preoperative renal function on prognosis after living donor liver transplantation (LDLT). Living donor liver transplantation cases were categorized into 3 groups as follows: renal failure with hemodialysis (HD; n=42), renal dysfunction (RD; n=94) (glomerular filtration rate <60 mL/min/1.73 m2), and normal renal function (NF; n=421). The study used no prisoners, and participants were neither coerced nor paid. The manuscript complies with the Helsinki Congress and the Declaration of Istanbul. Five-year overall survival (OS) rates were 59.0%, 69.3%, and 80.0% in the HD, RD, and NF groups, respectively (P < .01). The frequency of bacteremia within 90 days after LDLT was 76.2%, 37.2%, and 34.7%, respectively (P < .01 in HD vs RD and HD vs NF). Patients with bacteremia showed a worse outcome than those without (1-year OS, 65.6% vs 93.3%), thus corroborating the poor prognosis in the HD group. The high frequency of bacteremia in the HD group was mainly attributable to health care-associated bacterium, such as coagulase-negative Staphylococci, Enterococcus spp., and Pseudomonas aeruginosa. In the HD group, HD was started within 50 days before LDLT for acute renal failure in 35 patients, of which 29 (82.9%) successfully withdrew from HD after LDLT and demonstrated better prognosis (1-year OS, 69.0% vs 16.7%) than those who continued HD. Preoperative renal dysfunction is associated with poor prognosis after LDLT, possibly due to a high incidence of health care-associated bacteremia.

Early Detection of Epstein-Barr Virus as a Risk Factor for Chronic High Epstein-Barr Viral Load Carriage at a Living-donor-dominant Pediatric Liver Transplantation Center.

Epstein-Barr virus (EBV) infection and posttransplant lymphoproliferative disorders (PTLDs) after pediatric liver transplantation (LT) account for significant morbidity and mortality. Knowledge of EBV kinetics, epidemiology, and outcomes among pediatric living-donor LT cases is largely lacking. This study aims to provide clinical information related to EBV infection, chronic high EBV load (CHL) carriage, and PTLD at a living-donor-dominant pediatric LT center. A total of 5827 EBV load measurements from 394 LT recipients fulfilling inclusion criteria and their clinical data were analyzed. EBV loads >1000 copies/μg DNA (742 IU/μg DNA) were considered "high," and CHL was defined by persistence >6 mo. The highlighted results were as follows: (1) 94% of recipients underwent living-donor LT; (2) 80% of EBV seronegative recipients developed first EBV infection <2 y post-LT, and their EBV loads were consistently higher than those of seropositive recipients within <3 y post-LT but did not differ thereafter; (3) 61 (15%) recipients met CHL criteria, but none developed PTLD; (4) age <5 y, cytomegalovirus seronegative donors, and early development of EBV DNAemia <6 mo post-LT were independent risk factors for CHL; (5) the incidence of rejections after 1-y post-LT was comparably low among CHL carriers whose immunosuppression was minimized. Early detection of EBV following LT and CMV seronegative donors would facilitate risk stratification to prevent PTLD while titrating immunosuppression among pediatric LT recipients.

Increasing Living Liver Donor Pools: Liver Paired Exchange Versus ABO-incompatible Living Donor Liver Transplantation.

Increasing Living Liver Donor Pools: Liver Paired Exchange Versus ABO-incompatible Living Donor Liver Transplantation.

Surgical complications after living and deceased donor liver transplant: The NSQIP transplant experience.

This study used the prospective National Surgical Quality Improvement Program (NSQIP) Transplant pilot database to analyze surgical complications after liver transplantation (LT) in LT recipients from 2017to 2019. The primary outcome was surgical complication requiring intervention (Clavien-Dindo grade II or greater) within 90days of transplant. Of the 1684 deceased donor and 109 living donor LT cases included from 29 centers, 38% of deceased donor liver recipients and 47% of living donor liver recipients experienced a complication. The most common complications included biliary complications (19% DDLT; 31% LDLT), hemorrhage requiring reoperation (14% DDLT; 9% LDLT), and vascular complications (6% DDLT; 9% LDLT). Management of biliary leaks (35.3% ERCP, 38.0% percutaneous drainage, 26.3% reoperation) and vascular complications (36.2% angioplasty/stenting, 31.2% medication, 29.8% reoperation) was variable. Biliary (aHR 5.14, 95% CI 2.69-9.8, P<.001), hemorrhage (aHR 2.54, 95% CI 1.13-5.7, P=.024) and vascular (aHR 2.88, 95% CI .85-9.7, P=.089) complication status at 30-days post-transplant were associated with lower 1-year patient survival. We conclude that biliary, hemorrhagic and vascular complications continue to be significant sources of morbidity and mortality for LT recipients. Understanding the different risk factors for complications between deceased and living donor liver recipients and standardizing complication management represent avenues for continued improvement.

Adult Living Donor Liver Transplantation for the Carryover Patients After Kasai Operation Who Have a History of Multiple Laparotomies

Approximately 50 years have passed since the Kasai operation announcement for biliary atresia. In adult liver failure cases, the so-called "the carryover cases after Kasai operation" have increased. These patients often underwent polysurgery. In such cases, adult living-donor liver transplantation (LDLT) is occasionally difficult. Many complications have been reported to be caused by severe cholangitis, hepatic portal regional inflammation, and adhesion. We investigated the complications of adult LDLT in post-Kasai biliary atresia cases with polysurgery. Between 1991 and 2021, we performed 205 LDLT cases. Weinvestigated the outcome of adult LDLT for post-Kasai biliary atresia cases (transplanted over 16 years old) (n=20) and the risk factors for complications after LDLT. On 5 years overall survival, there were no significant differences between "adult LDLT for post-Kasai" group and the others (81.8% vs 81.2%).Adult LDLT for post-Kasai was not found to be a risk factor for complications. However, polysurgery before LDLT was an independent risk factor for biliary stenosis and portal stenosis, as identified in our univariate and multivariate analysis. We analyzed the relationship between biliary stenosis and the frequency of laparotomies using a receiver operating characteristic curve. The analysis showed that the cutoff point (maximum point of sensitivity plus specificity) was more than 3 times that of laparotomies before LDLT. In our study, adult LDLT for post-Kasai cases was not a risk factor for any complications. However, polysurgery before LDLT has been identified as a risk factor for biliary stenosis and portal vein stenosis.

The Clinical Implication of Hepatic Venous Territory Mapping in Living Donor Liver Transplantation Using Right Liver Graft

Background: We designed this study to evaluate the clinical implication of hepatic venous territory mapping in living donor liver transplantation. Method: Living donor liver transplantation cases performed using right liver graft since 2017 were included. Hepatic venous mapping using Volume viewer application in the AW server 3.2 was started since January 2019. Comparison between transplantation cases with venous mapping and cases without mapping were performed. Among patients with hepatic venous mapping, cut-off point for graft occlusion were analyzed. Results: Among 754 patients included to the study, 213 patients underwent hepatic venous mapping. Inferior hepatic vein reconstruction rate and patency rate were similar between the no mapping group and mapping group (25.2% vs. 28.8%, P=0.402 and 92.5% vs. 96.8%, P=0.412), respectively. While middle hepatic vein reconstruction rate was higher in the mapping group (67.3%) compared to the no mapping group. (55.8%, P=0.013) However, patency rate was higher in the no mapping group (63.5%) compared to the mapping group (51.1%, P=0.041). In patients with V5 reconstruction, median volume (177cm3, IQR 152-259 vs. 147cm3, IQR 113-199, P=0.006) and median percentage of V5 territory (22.3%, IQR 17.1-29.7 vs. 18.4%, IQR 14.9-21.8, P=0.001) were higher in the patent graft compared to occluded graft. A cut-off point of 150cm3 (sensitivity=0.824, specificity=0.533, AUC=0.680, P=0.006) and 20.0% (sensitivity=0.647, specificity=0.711, AUC=0.716, P=0.001) were chosen based on Youden’s index in area-under receiver operating characteristic analysis. Conclusions: Hepatic venous mapping provided objective measure for performing venous outflow reconstruction in living donor liver transplantation using right liver graft with increased reconstruction rate of the middle hepatic vein territory.

Complete Transition from Open to Laparoscopic Living Donor Hepatectomy: 8-Year Experience with More than 500 Laparoscopy Cases

Background: We designed this study to comprehensively review the laparoscopic living donor liver transplantation of our institution. Method: Living donor liver transplantation cases performed since the first laparoscopic living donor hepatectomy, until reaching 500th laparoscopic cases were reviewed. Laparoscopic cases were compared to open cases in a yearly basis, regarding the donor selection, donor morbidity, recipient morbidity and operation time. Results: During the period of May 2013 to July 2021, 754 living donor liver transplantations, 506 laparoscopic and 247 open cases were performed. Complete transition to laparoscopy was achieved in 2020, performing 112 transplantations laparoscopically. Variation of bile duct type of donor became similar in 2018. (P=1.000) There were no differences in the occurrence of grade III complication of donor and recipient throughout the study period. Mean donor operation time were significantly longer in the laparoscopy group which became similar since 2017 (P=0.313) There were no differences in the mean operation time of recipients throughout the study period. Regarding graft survival and overall survival of the recipient, there were no difference between the two group throughout the period. Conclusions: In the initial period, donor selection existed especially for bile duct variation maintaining the safety of the donor and recipient. However, with accumulated experience, complete transition to laparoscopy became possible after 7 years of practice.

Early graft calcification without graft dysfunction after living donor liver transplantation: two case reports

Graft calcification after liver transplantation (LT) has seldom been reported, but almost of all previously reported cases have been attributed to graft dysfunction. We herein report two cases of graft calcification without liver dysfunction after living donor liver transplantation (LDLT). Two patients who underwent LDLT were found to have graft calcification in the early postoperative period (< 1 month). Calcification in the first case was found at the cut edge of the liver at post-operative day (POD) 10, showing a time-dependent increase in calcification severity. The second patient underwent hepatic artery re-anastomosis due to hepatic artery thrombosis on POD4 and received balloon-occluded retrograde transvenous obliteration of the splenic kidney shunt due to decreased portal vein blood flow on POD6. She was found to have diffuse hepatic calcification in the distant hepatic artery area at 1-month post-operation followed by gradual graft calcification at the resection margin at 6-month post-operation. Neither case showed post-operative graft dysfunction. Calcification of the liver graft after LDLT is likely rare, and graft calcification does not seem to affect the short-term liver function in LDLT cases. We recommend strictly controlling the warm/cold ischemia time and reducing the physical damage to the donor specimen as well as monitoring for early calcification by computed tomography.

The Concept of Functional Graft Size: An Eternal Theme of Maximizing Donor Safety and Recipient Survival in Living Donor Liver Transplantation.

The Concept of Functional Graft Size: An Eternal Theme of Maximizing Donor Safety and Recipient Survival in Living Donor Liver Transplantation.

Laparoscopic living donor right hepatectomy regarding the anatomical variation of portal vein: A propensity score matched analysis

This study is designed to analyze the feasibility of laparoscopic living donor right hemihepatectomy in living donors with portal vein variation. Living donor liver transplantation cases with right liver graft during the period of January 2014 to September 2019 were included. Computed tomographic angiographies of the donor were three-dimensionally reconstructed, and the anatomical variation of the portal vein was classified. To reduce, selection bias, 1:1 ratio propensity score match analysis between the laparoscopy group and the open group was performed. Surgical and recovery-related outcome as well as portal vein complication-free survival, graft survival and overall survival were analyzed. After matching, 171 cases in each group from 444 original cases were compared. The laparoscopy group had shorter operation time (p < 0.001), smaller number of additional opioids required by the donor (p < 0.001), shorter hospital stay (p < 0.001). There were no difference in the portal vein complication-free survival (p = 0.16), graft survival (p = 0.26), and overall survival (p = 0.53). While portal vein complication-free survival was inferior in portal vein other than type I (p = 0.01), the laparoscopy showed similar portal vein complication-free survival whether the portal vein was type I (p = 0.35) or other types (p = 0.30). Laparoscopic living donor right hemihepatectomy can be performed as safely as open surgery regardless of the anatomical variation of portal vein.

Feasibility of external biliary drainage in living donor liver transplantation: Lessons learned from initial experiences in single center

Biliary complication is the most common and unmanageable complication of living donor liver transplantation (LDLT). External biliary drainage (EBD) is one of the strategies to decrease the incidence of biliary complication. Herein, we examined the LDLT cases with EBD application and evaluated the outcome of patients to assess whether EBD is a practicable surgical method to reduce biliary problem. This study was a single-center case series study performed at Seoul National University Hospital. All adult LDLT patients with EBD application during bile duct anastomosis were included from April 2019 to May 2020. Demographic data and the rates of biliary complication and EBD-related complication were demonstrated. Median follow-up period was 15 months. EBD techniques were applied during bile duct anastomosis in 45 cases of adult LDLT patients during study period. In most cases (95.6%), duct-to-duct anastomosis was performed. Median diameter of bile duct opening was 4 mm (range 1.5-16 mm). More than 2 bile duct openings were observed in 26 cases (57.8%). With application of EBD, incidence of biliary complications was 35.6% (n = 16); concretely, leakage in 2 cases (4.4%) and stricture in 14 cases (31.1%). EBD-related complications, such as retraction, accidental removal, and dislocation, were found in 19 cases (42.2%). EBD is worthwhile in selected patients with a high risk of anastomotic bile leakage, such as multiple and/or small openings of bile duct. However, efforts should be exerted regarding EBD-related complications. Further study is needed to establish appropriate selection criteria for EBD.

Laparoscopic Living Donor Right Hepatectomy Regarding the Anatomical Variation of the Portal Vein: A Propensity Score-Matched Analysis.

This study is designed to analyze the feasibility of laparoscopic living donor right hemihepatectomy in living donors with portal vein variation. Living donor liver transplantation cases using a right liver graft during the period of January 2014 to September 2019 were included. Computed tomographic angiographies of the donor were 3-dimensionally reconstructed, and the anatomical variation of the portal vein was classified. To reduce selection bias, a 1:1 ratio propensity score-matched analysis between the laparoscopy group and the open group was performed. Surgical and recovery-related outcomes as well as portal vein complication-free survival, graft survival, and overall survival rates were analyzed. After matching, 171 cases in each group from 444 original cases were compared. The laparoscopy group had a shorter operation time (P<0.001), a smaller number of additional opioids required by the donor (P<0.001), and a shorter hospital stay (P<0.001). There were no differences in the portal vein complication-free survival (P=0.16), graft survival (P=0.26), or overall survival rates (P=0.53). Although portal vein complication-free survival was inferior in portal veins other than type I (P=0.01), the laparoscopy group showed similar portal vein complication-free survival regardless of the anatomical variation of portal vein (P=0.35 in type I and P=0.30 in other types). Laparoscopic living donor right hemihepatectomy can be performed as safely as open surgery regardless of the anatomical variation of the portal vein.

Pediatric living-donor liver transplantation using right posterior segment grafts

BackgroundThe right posterior segment (RPS) graft was introduced to overcome graft size discrepancy in living donor liver transplantation (LDLT). However, it was very rarely used in pediatric patients. Here we presented 4 pediatric LDLT cases receiving RPS graft between January 2015 and April 2020 in our center. A total of 1868 LDLT procedures were performed in this period.MethodsRecipients included 1 boy and 3 girls with a median age of 45 months (range from 40 to 93 months). They were diagnosed with progressive familial intrahepatic cholestasis, propionic academia, ornithine transcarbamylase and biliary atresia, respectively. Four donors were all mothers with a median age of 32.5 years (31–38 years). Computer tomography angiography indicated posterior right branches branched off separately from main portal veins (type III variation). Three of these donor livers had 1 orifice of right hepatic veins (RHV). In the remaining 1 donor liver, the RHV showed 3 orifices and an outflow patch plastic was performed. Inferior right hepatic veins weren’t found in four donor grafts. The median graft weight was 397.5 g (352–461 g) and the median graft-to-recipient weight ratio was 2.38% (1.44–2.80%).ResultsPostoperative complications occurred in neither donors nor recipients. Within the median follow-up duration of 29 months (14–64 months), four children are all alive with normal liver function.ConclusionIn summary, for older children weighed more than 15 kg with donors’ variation of type III portal veins, the use of RPS grafts could be a feasible and favorable option.

Donor age (≥45years) and reduced immunosuppression are associated with the recurrent primary sclerosing cholangitis after liver transplantation - a multicenter retrospective study.

The present study investigated the possible risk factors, including relationship/HLA matching between donor and recipient, and immunosuppressive therapies on the recurrence of primary sclerosing cholangitis (PSC) after liver transplantation (LT). Subjects were 197 recipients of LT for PSC, among whom 180 surviving more than 1year after LT were further analyzed for risk factors of recurrence. The 5- and 10-year patient- and graft survival rates were 83% and 68%, and 71% and 62%, respectively. The overall PSC recurrence rate was 25% with a 5- and 10-year graft survival rate of 34% and 18%, which was significantly lower than the survival rate of those without recurrence (P<0.001). Univariate analysis identified the following as risk factors for recurrence: donor age (P<0.001), cyclosporine use (P=0.012), mono or no immunosuppressive agent (P<0.001), postoperative biliary complication (P<0.001), and active intestinal bowel disease after LT (P<0.001). Among these factors, donor age ≥45years [hazard ratio (HR), 1.65; 95% confidence interval (CI), 1.21-2.69; P=0.003] and mono or no immunosuppressive agent 1-year after LT (HR, 2.38; 95% CI, 1.23-3.45; P=0.011) were identified as independent risk factors in the final multivariate Cox regression model. The results were similar in sub-analysis for ABO-identical/compatible adult living donor LT cases.

Inferior Vena Cava and Venous Outflow Reconstruction in Living Donor Liver Transplantation in Children: A Single-Center Retrospective Study and Literature Review.

BackgroundIn this report, we present technical problems and solutions used in the reconstruction of the inferior vena cava and graft venous outflow during living donor liver transplantation (LDLT) in children.Material/MethodsIn 65 grafts out of 379 liver transplantations from living donors, reconstruction of multiple hepatic venous branches and/or IVC was necessary. In 4 cases, cryopreserved deceased donor venous grafts were used for the reconstruction of the IVC and/or HV.ResultsFollow-up ranged from 2 months to 17.8 years (median 7.2 years). In 4 children, liver re-transplantation was required for a reason not related to venous outflow (biliary complications in 3 patients, graft insufficiency caused by small-for-size syndrome). Two patients died: 1 due to tumor recurrence and 1 due to multi-organ failure. Fifty-nine patients are alive with good liver function. One patient (1.5%) after deceased donor venous graft reconstruction showed symptoms of venous outflow obstruction, which was successfully treated with endovascular balloon angioplasty and stent placement. The remaining 59 transplanted patients do not show any signs of venous outflow obstruction.ConclusionsIn most cases, the reconstruction of multiple hepatic veins of living donor allografts can successfully be done with local venoplasty, while using cold-stored vein grafts may be helpful in selected cases of LDLT.

No diffuse intrahepatic biliary stricture after ABO-incompatible adult living donor liver transplantation using tailored rituximab-based desensitization protocol.

BackgroundRituximab (RTx) desensitization protocol offered good outcome in ABO-incompatible (ABOi) living donor liver transplantation (LDLT). However, diffuse intrahepatic biliary stricture (DIHBS) is still inevitable hurdle. We selectively added postoperative high dose intravenous immunoglobulin (IVIG) and/or simultaneous splenectomy if ABO isoagglutinin titer just before liver transplantation after plasma exchange (PE) was higher than 1/16. Herein, we reported the excellent outcome of ABOi LDLT without DIHBS using tailored desensitization protocol and compared it with that of ABO-compatible (ABOc) LDLT.MethodsSixty-five cases (14.8%) of ABOi LDLTs were performed among 438 primary adult LDLTs in our center between March 2012 and June 2017. We performed 1-to-2 propensity score matching (PSM) to extract 60 cases of ABOi LDLTs and 120 cases of ABOc LDLTs.ResultsThere were no significant differences in clinical characteristics between ABOi and ABOc recipients. There were no significant differences in complications and rejection. There was no DIHBS in both groups. The 1-, 3-, and 5-year overall survival rates were 98.3%, 86.7%, and 82.9% in ABOi group and 96.7%, 86.7%, and 85.4% in ABOc group, respectively (P=0.88). Most common cause of deaths of both groups was hepatocellular recurrence. The 1-, 3-, and 5-year biliary complication (anastomosis leakage or stricture) free survival rates were 81.4%, 69.5%, and 67.5% in ABOi group and 83.0%, 81.3%, and 80.0% in ABOc group, with no significant differences (P=0.11).ConclusionsRTx-based tailored (optional IVIG + splenectomy) desensitization protocol for ABOi LDLT was feasible and acceptable.

Outcomes of living versus deceased donor liver transplantation: initial single center experience from Thailand

Background: The availability of deceased donor in the northern region of Thailand is limited. In 2015, we initiated the adult to adult living donor liver transplantation program. To date, we are the only active adult to adult living donor liver transplantation pro gram in Thailand. We evaluated the short-term outcomes after liver transplantation compare between living and deceased donor liver transplantation. Methods: Retrospective study of adult liver transplantation in our center since 2014. The patients were divided in to a living do nor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT). Baseline characteristic, perioperative data and 1-year survival were compared between two groups. Results: There were 37 cases underwent LT in our hospital since October 2014 (20 DDLT cases and 17 LDLT cases). Baseline characteristics between two groups were not significantly difference. The operative time was longer in LDLT group (P<0.001). However, cold and warm ischemic time were shorter in LDLT group (P<0.001 and P=0.026, respectively). The median ventilator, intensive care unit and hospital stay were similar. The incidence of biliary complication was higher in LDLT group (47% vs 10%, P<0.001). The vascular related complications were not significant difference. Nighty-day and 1-year survival were not significant difference between LDLT and DDLT group (84.6% vs. 84.2% and 76.9% vs. 84.2% respectively, P=0.706). Conclusions: In the region where deceased donor shortage, LDLT showed similar results compare to DDLT in terms of peri-oper ative outcomes and patient survival even done by the beginner LDLT program. However, the incidence of biliary related complica tion was significant higher in LDLT group.

Poor outcomes of early recurrent post-transplant bloodstream infection in living-donor liver transplant recipients.

Bloodstream infection (BSI) is a common complication after living-donor liver transplantation (LDLT). Some patients develop recurrent BSIs. We evaluated the impacts of early recurrent BSIs (ER-BSIs) on outcomes in LDLT recipients. LDLT cases between 2008 and 2016 were included. Early BSI (E-BSI) was defined as a BSI event that occurred within 2 months after LDLT. ER-BSIs were defined as new-onset BSIs within 2 months due to another pathogen at a ≥ 48-h interval or a relapse of BSIs by the same pathogen at a ≥ 1-week interval, with negative cultures in between. The primary objective was evaluating the all-cause mortality of each group of LDLT recipients (90 days and 1 year). The secondary objectives were analyzing associated factors of each all-cause mortality and risk factors for early single BSI and ER-BSI. Among 727 LDLT recipients, 108 patients experienced 149 events of E-BSI with 170 isolated pathogens. Twenty-eight patients (25.9%, 28/108) experienced ER-BSI. The 1-year survival rates of patients without BSI, with early single BSI event, and with ER-BSIs were 92.4%, 81.3%, and 28.6%, respectively. ER-BSI was the most significant risk factor for 1-year mortality (adjusted HR = 5.31; 95% CI = 2.27–12.40). Intra-abdominal and/or biliary complications and early allograft dysfunction were risk factors for both early single BSI and ER-BSI. Interestingly, longer cold ischemic time and recipient operative time were associated with ER-BSI. LDLT recipients with ER-BSI showed very low survival rates accompanied by intra-abdominal complications. Clinicians should prevent BSI recurrence by being aware of intra-abdominal complications.Electronic supplementary materialThe online version of this article (10.1007/s10096-020-04074-5) contains supplementary material, which is available to authorized users.