Factors Predicting Outcome after Living Donor Liver Transplantation in the Era of Intra-Operative Flow Measurements and Inflow Modulation
University of Pittsburgh Medical Center, Pittsburgh, PA
Meeting: 2020 American Transplant Congress
Abstract number: 473
Keywords: Graft function, Liver grafts, Liver transplantation, Ultrasonography
Session Information
Session Name: Liver: Living Donors and Partial Grafts II
Session Type: Oral Abstract Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:45pm
Presentation Time: 3:51pm-4:03pm
Location: Virtual
*Purpose: To identify pre/intra-operative factors which predict adverse outcome after living donor liver transplantation (LDLT).
*Methods: All patients who underwent first LDLT at UPMC, Pittsburgh from January 2011 to November 2019, who had the hepatic artery (HA) flow and portal vein (PV) flow measured and recorded, were analyzed. Basic donor and recipient demographics were analyzed. Intra-operative factors included HA flow and PV flow. The PV pressure was kept below 20 mmHg in all recipients by inflow modulation. HA/PV flow ratio was calculated by dividing the two. Normal HA flow was defined as more than 100 ml/min and normal PV flow was defined as 100-250 ml/min/100 gm of graft weight. Flow was classified normal or abnormal. Post operative outcome including adverse vascular events (hepatic artery thrombosis, hepatic artery stenosis, portal vein thrombosis and portal vein stenosis) were analyzed.
*Results: 229 patients were analyzed. There was no other significant difference between patients with Normal or Abnormal flow dynamics based on pre-operative and intra-operative factors except the MELD score. No patient developed PNF or EAD. The liver function profile on Day 7 after transplant was not different. There were 14 patients who developed adverse vascular events. Longer WIT was tending towards significance for adverse vascular events. Flow dynamics were not significant for adverse vascular events. On follow up, all-cause mortality was 12.2%. Longer WIT and high GRWR was significant for mortality.
*Conclusions: Most factors that cause adverse vascular events and mortality can be controlled by inflow modulation in LDLT. However, longer WIT continues to be predictor of poor outcome. Patients who died after transplantation also had higher graft weight and lower portal flows, so a better matching of graft flow dynamics would be beneficial.
| Total(N=229) | Abnormal(N=144) | Normal(N=85) | P value | |
|
Recipient age (yrs)
Mean (SD)
|
56.9(11.7) | 56.7(12) | 57.1(11.2) | 0.82 |
|
Recipient MELD
Mean (SD)
|
15.2 (5.9) | 15.9(5.8) | 13.9(5.9) | 0.014 |
| WIT (min), Mean (SD) | 29.4 (9) | 29.5 (9.2) | 29.2(8.8) | 0.78 |
| CIT (min)Mean (SD) | 129.1(110.2) | 130.6(134.2) | 126.6(46.7) | 0.74 |
| GRWRMean | 1.1(0.3) | 1.1(0.4) | 1.1(0.3) | 0.52 |
| Recipient length of stay (days), Median (IQR) | 11(7-18) | 11(7-19) | 10(7-17) | 0.33 |
|
Donor age (yrs)
Mean (SD)
|
37.4(9.5) | 38.3(9.5) | 35.8(9.5) | 0.07 |
| No adverse events(N=215) | Adverse vascular events(N=14) | Total(N=229) | P value | |
| HA flow Mean (SD) | 123 (127) | 128.2(110.2) | 123.3(125.8) | 0.88 |
| PV flow Mean(SD) | 177.9(72.4) | 169(60.3) | 177.3(71.6) | 0.66 |
| HA/PV flow ratio Mean (SD) | 0.9(1.3) | 0.9(0.8) | 0.9(1.3) | 0.88 |
| GRWR Mean (SD) | 1.1(0.3) | 1.0(0.3) | 1.1(0.3) | 0.17 |
|
CIT (min)
Mean (SD)
|
129.1(113.5) | 129.6(42.9) | 129.1(110.4) | 0.97 |
|
WIT (min)
Mean (SD)
|
29.1 (8.8) | 33.4(11.4) | 29.4(9) | 0.09 |
| Abnormal flow dynamics | 135(62.8%) | 9(64.3%) | 144(62.9%) | 0.91 |
| Alive(N=201) | Dead(N=28) | Total(N=229) | P value | |
| HA flowMean (SD) | 123.7(131.8) | 120.2(71) | 123.3(125.8) | 0.83 |
| PV flowMean (SD) | 180(71.4) | 158.4(71.4) | 177.3(71.6) | 0.14 |
| HA/PV flow ratioMean (SD) | 0.9(1.4) | 1(0.9) | 0.9(1.3) | 0.5 |
| GRWRMean (SD) | 1.1(0.3) | 1.2(0.3) | 1.1(0.3) | 0.04 |
|
CIT (min)
Mean (SD)
|
130.8(116.7) | 116.8(36) | 129.1(110.4) | 0.2 |
|
WIT (min)
Mean (SD)
|
28.4(8.3) | 36.3(11.1) | 29.4(9) | 0.001 |
| Abnormal flow dynamics | 128(63.7) | 16(57.1) | 144(62.9) | 0.5 |
To cite this abstract in AMA style:
Sonbare D, Jorgensen D, Humar A. Factors Predicting Outcome after Living Donor Liver Transplantation in the Era of Intra-Operative Flow Measurements and Inflow Modulation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/factors-predicting-outcome-after-living-donor-liver-transplantation-in-the-era-of-intra-operative-flow-measurements-and-inflow-modulation/. Accessed November 21, 2024.« Back to 2020 American Transplant Congress