Adult-to-adult living-donor liver transplantation: The experience of the Université catholique de Louvain

摘要

Background:Liver transplantation is the treatment for end-stage liver diseases and well-selected malignancies.The allograft shortage may be alleviated with living donation.The initial UCLouvain experience of adult living-donor liver transplantation (LDLT) is presented.Methods:A retrospective analysis of 64 adult-to-adult LDLTs performed at our institution between 1998 and 2016 was conducted.The median age of 29 (45.3％) females and 35 (54.7％) males was 50.2 years (interquartile range,IQR 32.9-57.5).Twenty-two (34.4％) recipients had no portal hypertension.Three (4.7％)patients had a benign and 33 (51.6％) a malignant tumor [19 (29.7％) hepatocellular cancer,11 (17.2％)secondary cancer and one (1.6％) each hemangioendothelioma,hepatoblastoma and embryonal liver sarcoma].Median donor and recipient follow-ups were 93 months (IQR 41-159) and 39 months (22-91),respectively.Results:Right and left hemi-livers were implanted in 39 (60.9％) and 25 (39.1％) cases,respectively.Median weights of right-and left-liver were 810g (IQR 730-940) and 454g (IQR 394-534),respectively.Graft-to-recipient weight ratios (GRWRs) were 1.17％ (right,IQR 0.98％-1.4％) and 0.77％ (left,0.59％-0.95％).One-and five-year patient survivals were 85％ and 71％ (fight) vs.84％ and 58％ (left),respectively.Oneand five-year graft survivals were 74％ and 61％ (right) vs.76％ and 53％ (left),respectively.The patient and graft survival of right and left grafts and of very small (＜0.6％),small (0.6％-0.79％) and large (＞0.8％)GRWR were similar.Survival of very small grafts was 86％ and 86％ at 3-and 12-month.No donor died while five (7.8％) developed a Clavien-Dindo complication Ⅲia,Ⅲb or Ⅳ.Recipient morbidity consisted mainly of biliary and vascular complications;three (4.7％) recipients developed a small-for-size syndrome according to the Kyushu criteria.Conclusions:Adult-to-adult LDLT is a demanding procedure that widens therapeutic possibilities of many hepatobiliary diseases.The donor procedure can be done safely with low morbidity.The recipient operation carries a major morbidity indicating an important learning curve.Shifting the risk from the donor to the recipient,by moving from the larger right-liver to the smaller left-liver grafts,should be further explored as this policy makes donor hepatectomy safer and may stimulate the development of transplant oncology.