Complications and Their Resolution in Recipients of Deceased and Living Donor Liver Transplants: Findings From the A2ALL Cohort Study
The purpose of this study was to explore 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). We analyzed 471 DDLTs and 565 LDLTs from 1998 to 2010 that...
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| Veröffentlicht in: | American journal of transplantation 2016-02, Vol.16 (2), p.594-602 |
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| creator | Samstein, B. Smith, A.R. Freise, C.E. Zimmerman, M.A. Baker, T. Olthoff, K.M. Fisher, R.A. Merion, R.M. |
| description | The purpose of this study was to explore 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). We analyzed 471 DDLTs and 565 LDLTs from 1998 to 2010 that were followed up to 10 years for 36 categories of complications. Probabilities of complications and their resolutions were estimated using the Kaplan–Meier method, and predictors were tested in Cox proportional hazards models. Median follow-up for DDLT and LDLT was 4.19 and 4.80 years, respectively. DDLT recipients were more likely to have hepatocellular carcinoma and higher disease severity, including Model for End-Stage Liver Disease score. Complications occurring with higher probability in LDLT included biliary-related complications and hepatic artery thrombosis. In DDLT, ascites, intra-abdominal bleeding, cardiac complications and pulmonary edema were significantly more probable. Development of chronic kidney disease stage 4 or 5 was less likely in LDLT recipients (hazard ratio [HR] 0.41, p = 0.02). DDLT and LDLT had similar risk of grade 4 complications (HR 0.89, p = 0.60), adjusted for other risk factors. Once a complication occurred, the time to resolution did not differ between LDLT and DDLT. Future efforts should be directed toward reducing the occurrence of complications after liver transplantation. |
| doi_str_mv | 10.1111/ajt.13479 |
| format | Article |
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We analyzed 471 DDLTs and 565 LDLTs from 1998 to 2010 that were followed up to 10 years for 36 categories of complications. Probabilities of complications and their resolutions were estimated using the Kaplan–Meier method, and predictors were tested in Cox proportional hazards models. Median follow-up for DDLT and LDLT was 4.19 and 4.80 years, respectively. DDLT recipients were more likely to have hepatocellular carcinoma and higher disease severity, including Model for End-Stage Liver Disease score. Complications occurring with higher probability in LDLT included biliary-related complications and hepatic artery thrombosis. In DDLT, ascites, intra-abdominal bleeding, cardiac complications and pulmonary edema were significantly more probable. Development of chronic kidney disease stage 4 or 5 was less likely in LDLT recipients (hazard ratio [HR] 0.41, p = 0.02). DDLT and LDLT had similar risk of grade 4 complications (HR 0.89, p = 0.60), adjusted for other risk factors. Once a complication occurred, the time to resolution did not differ between LDLT and DDLT. Future efforts should be directed toward reducing the occurrence of complications after liver transplantation.</description><identifier>ISSN: 1600-6135</identifier><identifier>EISSN: 1600-6143</identifier><identifier>DOI: 10.1111/ajt.13479</identifier><identifier>PMID: 26461803</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Ascites ; Cadaver ; Cohort analysis ; Edema ; End Stage Liver Disease - surgery ; Female ; Follow-Up Studies ; Graft Rejection - etiology ; Graft Rejection - prevention & control ; Graft Survival ; Health risks ; Hepatic artery ; Hepatocellular carcinoma ; Humans ; Kidney diseases ; Liver ; Liver cancer ; Liver diseases ; Liver transplantation ; Liver Transplantation - adverse effects ; Liver transplants ; Living Donors ; Male ; Middle Aged ; Postoperative Complications ; Prognosis ; Risk Factors ; Thrombosis ; Transplant Recipients ; Transplants & implants</subject><ispartof>American journal of transplantation, 2016-02, Vol.16 (2), p.594-602</ispartof><rights>2016 American Society of Transplantation & American Society of Transplant Surgeons. 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All rights reserved.</rights><rights>Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons</rights><rights>Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.</rights><rights>2016 the American Society of Transplantation and the American Society of Transplant Surgeons</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5159-29e2ddd74baccef2769d8f69374ae41bee2a31d5d8df2bb990d76fd47f0cd56b3</citedby><cites>FETCH-LOGICAL-c5159-29e2ddd74baccef2769d8f69374ae41bee2a31d5d8df2bb990d76fd47f0cd56b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fajt.13479$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fajt.13479$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26461803$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Samstein, B.</creatorcontrib><creatorcontrib>Smith, A.R.</creatorcontrib><creatorcontrib>Freise, C.E.</creatorcontrib><creatorcontrib>Zimmerman, M.A.</creatorcontrib><creatorcontrib>Baker, T.</creatorcontrib><creatorcontrib>Olthoff, K.M.</creatorcontrib><creatorcontrib>Fisher, R.A.</creatorcontrib><creatorcontrib>Merion, R.M.</creatorcontrib><title>Complications and Their Resolution in Recipients of Deceased and Living Donor Liver Transplants: Findings From the A2ALL Cohort Study</title><title>American journal of transplantation</title><addtitle>Am J Transplant</addtitle><description>The purpose of this study was to explore 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). 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Once a complication occurred, the time to resolution did not differ between LDLT and DDLT. 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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Ascites Cadaver Cohort analysis Edema End Stage Liver Disease - surgery Female Follow-Up Studies Graft Rejection - etiology Graft Rejection - prevention & control Graft Survival Health risks Hepatic artery Hepatocellular carcinoma Humans Kidney diseases Liver Liver cancer Liver diseases Liver transplantation Liver Transplantation - adverse effects Liver transplants Living Donors Male Middle Aged Postoperative Complications Prognosis Risk Factors Thrombosis Transplant Recipients Transplants & implants |
| title | Complications and Their Resolution in Recipients of Deceased and Living Donor Liver Transplants: Findings From the A2ALL Cohort Study |
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