Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Adult-to-adult living-donor LT (AALDLT) has been proposed to alleviate allograft shortage. However, it is not commonly considered in Western countries due to easier access to deceased donation, when compared to Eastern countries, and sometimes risky graft-to-recipient body weight ratio (GRBWR). We hypothesized that a priori computation of MELD status and GRBWR might predict LT outcome.
*Methods: Between 1998 and October 2018 a total of 68 AALDLT were performed at our Centre. Main indications were primary (23/68, 33.8%) and secondary (12/68, 17.6%) liver tumours, cholestatic liver disease (13/68, 19.1%), and alcoholic cirrhosis 10/68 (14.7). The median MELD was 11 (interquartile range, IQR 7-16). After donor medical and liver volume assessment using MeVis software, 28/68 (41.2%) liver donors underwent full left and 40/68 cases (58.8%) right hepatectomy. The median GRBWR was 0.99% (IQR 0.78-1.21%).
*Results: Overall 3-month patient and graft survivals were 85% and 79%. Retransplantation rate was 12%. Causes of mortality were: sepsis (4/10, 40%), sudden cardiac arrest (2/10, 20%), multi-organ failure (3/10, 30%), coeliac trunk dissection with subsequent bleeding (1/10, 10%). Indications for retransplantation were: hepatic artery thrombosis (2/8, 25%), portal vein thrombosis (2/8, 25%), small-for-size syndrome (2/8, 25%), graft failure after caval thrombosis (1/8, 12.5%), massive bleeding from hepatic artery (1/8, 12.5%). Patients were categorized retrospectively with respect to their MELD status (<15 vs. ≥15), as well as to their GRBWR (<0.8% vs. ≥0.8%). Four sub-groups of recipients were identified accordingly, with their respective 3-month patient death rate: group 1 (MELD<15; GRBWR<0.8): 1/13 (7.7%); group 2 (MELD<15; GRBWR ≥0.8): 2/31 (6.5%); group 3 (MELD≥15; GRBWR<0.8): 1/4 (25.0%); group 4 (MELD≥15; GRBWR ≥0.8) 6/20 (30.0%). The difference in the death rate was statistically significant only for group 2 vs. group 4 (p=0.045).
*Conclusions: Regardless of graft size, the severity liver disease seemed, in this work, to constitute the prominent predictor of 3-month outcome after AALDLT. In high MELD patients, additional strategies (portal vein modulation including porto-caval shunt) and staged RAPID techniques might be considered.
To cite this abstract in AMA style:Iesari S, Reding R, Lerut J, Bonaccorsi-Riani E, Coubeau L, Ciccarelli O. Adult-to-Adult Living-Donor Liver Transplantation: Towards a Prediction of Three-Month Survival Combining Graft-to-Recipient Weight and MELD in a Caucasian Population [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/adult-to-adult-living-donor-liver-transplantation-towards-a-prediction-of-three-month-survival-combining-graft-to-recipient-weight-and-meld-in-a-caucasian-population/. Accessed February 29, 2020.
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