Adult-to-adult living-donor liver transplantation: The experience of the Université catholique de Louvain
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. A retrospective analysis of 64 adult-to...
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| Veröffentlicht in: | Hepatobiliary & pancreatic diseases international 2019-04, Vol.18 (2), p.132-142 |
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| creator | Iesari, Samuele Inostroza Núñez, Milton Eduardo Rico Juri, Juan Manuel Ciccarelli, Olga Bonaccorsi-Riani, Eliano Coubeau, Laurent Laterre, Pierre-François Goffette, Pierre De Reyck, Chantal Lengelé, Benoît Gianello, Pierre Lerut, Jan |
| description | 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.
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.
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 810 g (IQR 730–940) and 454 g (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% (right) vs. 84% and 58% (left), respectively. One- and 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 ( |
| doi_str_mv | 10.1016/j.hbpd.2019.02.007 |
| format | Article |
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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.
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 810 g (IQR 730–940) and 454 g (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% (right) vs. 84% and 58% (left), respectively. One- and 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 IIIa, 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.
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.</description><identifier>ISSN: 1499-3872</identifier><identifier>DOI: 10.1016/j.hbpd.2019.02.007</identifier><identifier>PMID: 30850341</identifier><language>eng</language><publisher>Singapore: Elsevier B.V</publisher><subject>Adult ; Age Factors ; Belgium ; Cohort Studies ; Female ; Graft Rejection ; Graft Survival ; Hepatectomy - methods ; Hepatocellular cancer ; Hospitals, University ; Humans ; Liver Failure - surgery ; Liver Neoplasms - surgery ; Liver transplantation ; Liver Transplantation - methods ; Liver Transplantation - mortality ; Living Donors ; Living-donor ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Assessment ; Secondary liver tumor ; Small-for-size graft ; Small-for-size syndrome ; Survival Analysis ; Transplant Recipients ; Treatment Outcome</subject><ispartof>Hepatobiliary & pancreatic diseases international, 2019-04, Vol.18 (2), p.132-142</ispartof><rights>2019 First Affiliated Hospital, Zhejiang University School of Medicine in China</rights><rights>Copyright © 2019 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.</rights><rights>Copyright © Wanfang Data Co. Ltd. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c392t-f25935028f437eda445312fbdff0a971e6a966fe79142f7a1ac4d6a241b1b8be3</citedby><cites>FETCH-LOGICAL-c392t-f25935028f437eda445312fbdff0a971e6a966fe79142f7a1ac4d6a241b1b8be3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Uhttp://www.wanfangdata.com.cn/images/PeriodicalImages/gjgdybzz-z/gjgdybzz-z.jpg</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.hbpd.2019.02.007$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,778,782,3539,27907,27908,45978</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30850341$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Iesari, Samuele</creatorcontrib><creatorcontrib>Inostroza Núñez, Milton Eduardo</creatorcontrib><creatorcontrib>Rico Juri, Juan Manuel</creatorcontrib><creatorcontrib>Ciccarelli, Olga</creatorcontrib><creatorcontrib>Bonaccorsi-Riani, Eliano</creatorcontrib><creatorcontrib>Coubeau, Laurent</creatorcontrib><creatorcontrib>Laterre, Pierre-François</creatorcontrib><creatorcontrib>Goffette, Pierre</creatorcontrib><creatorcontrib>De Reyck, Chantal</creatorcontrib><creatorcontrib>Lengelé, Benoît</creatorcontrib><creatorcontrib>Gianello, Pierre</creatorcontrib><creatorcontrib>Lerut, Jan</creatorcontrib><title>Adult-to-adult living-donor liver transplantation: The experience of the Université catholique de Louvain</title><title>Hepatobiliary & pancreatic diseases international</title><addtitle>Hepatobiliary Pancreat Dis Int</addtitle><description>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.
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.
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 810 g (IQR 730–940) and 454 g (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% (right) vs. 84% and 58% (left), respectively. One- and 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 IIIa, 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.
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.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Belgium</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Graft Rejection</subject><subject>Graft Survival</subject><subject>Hepatectomy - methods</subject><subject>Hepatocellular cancer</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Liver Failure - surgery</subject><subject>Liver Neoplasms - surgery</subject><subject>Liver transplantation</subject><subject>Liver Transplantation - methods</subject><subject>Liver Transplantation - mortality</subject><subject>Living Donors</subject><subject>Living-donor</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Secondary liver tumor</subject><subject>Small-for-size graft</subject><subject>Small-for-size syndrome</subject><subject>Survival Analysis</subject><subject>Transplant Recipients</subject><subject>Treatment Outcome</subject><issn>1499-3872</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1DAUhb0A0VJ4ARbISySUYDvOjxGbquJPGolNu7ac-HrGUcYOtjOl80Y8By-GQwpLVr62vnvu9TkIvaKkpIQ278by0M-6ZISKkrCSkPYJuqRciKLqWnaBnsc4EsK6rm6eoYuKdDWpOL1E47VeplQkX6i1wJM9WbcvtHc-rBcIOAXl4jwpl1Sy3r3HtwfA8GOGYMENgL3BKb_cuZWONv36iQeVDn6y3xfAGvDOLydl3Qv01KgpwsvH8wrdffp4e_Ol2H37_PXmelcMlWCpMKwWVZ1XNbxqQSvO64oy02tjiBIthUaJpjHQCsqZaRVVA9eNYpz2tO96qK7Q2033Xjmj3F6OfgkuT5T7ca8f-vNZnlefCMsuZfrNRs_B531jkkcbB5jyf8EvUTLaibqmjPKMsg0dgo8xgJFzsEcVHiQlck1BjnJNQa7qkjC56b9-1F_6I-h_LX8jyMCHDYDsyclCkHH4Y6y2AYYktbf_0_8NMNCczA</recordid><startdate>20190401</startdate><enddate>20190401</enddate><creator>Iesari, Samuele</creator><creator>Inostroza Núñez, Milton Eduardo</creator><creator>Rico Juri, Juan Manuel</creator><creator>Ciccarelli, Olga</creator><creator>Bonaccorsi-Riani, Eliano</creator><creator>Coubeau, Laurent</creator><creator>Laterre, Pierre-François</creator><creator>Goffette, Pierre</creator><creator>De Reyck, Chantal</creator><creator>Lengelé, Benoît</creator><creator>Gianello, Pierre</creator><creator>Lerut, Jan</creator><general>Elsevier B.V</general><general>Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy%Hepatobiliopancreatic Unit, Las Higueras Hospital, Talcahuano, Chile%Cirugía de Trasplantes, Centro Médico Imbanaco, Cali, Colombia%Starzl Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain,Avenue Hippocrates 10, 1200 Brussels, Belgium%Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy%Department of Radiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium%Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium%P(o)le de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium</general><general>Starzl Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain,Avenue Hippocrates 10, 1200 Brussels, Belgium</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>2B.</scope><scope>4A8</scope><scope>92I</scope><scope>93N</scope><scope>PSX</scope><scope>TCJ</scope></search><sort><creationdate>20190401</creationdate><title>Adult-to-adult living-donor liver transplantation: The experience of the Université catholique de Louvain</title><author>Iesari, Samuele ; Inostroza Núñez, Milton Eduardo ; Rico Juri, Juan Manuel ; Ciccarelli, Olga ; Bonaccorsi-Riani, Eliano ; Coubeau, Laurent ; Laterre, Pierre-François ; Goffette, Pierre ; De Reyck, Chantal ; Lengelé, Benoît ; Gianello, Pierre ; Lerut, Jan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c392t-f25935028f437eda445312fbdff0a971e6a966fe79142f7a1ac4d6a241b1b8be3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Belgium</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Graft Rejection</topic><topic>Graft Survival</topic><topic>Hepatectomy - methods</topic><topic>Hepatocellular cancer</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Liver Failure - surgery</topic><topic>Liver Neoplasms - surgery</topic><topic>Liver transplantation</topic><topic>Liver Transplantation - methods</topic><topic>Liver Transplantation - mortality</topic><topic>Living Donors</topic><topic>Living-donor</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Secondary liver tumor</topic><topic>Small-for-size graft</topic><topic>Small-for-size syndrome</topic><topic>Survival Analysis</topic><topic>Transplant Recipients</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Iesari, Samuele</creatorcontrib><creatorcontrib>Inostroza Núñez, Milton Eduardo</creatorcontrib><creatorcontrib>Rico Juri, Juan Manuel</creatorcontrib><creatorcontrib>Ciccarelli, Olga</creatorcontrib><creatorcontrib>Bonaccorsi-Riani, Eliano</creatorcontrib><creatorcontrib>Coubeau, Laurent</creatorcontrib><creatorcontrib>Laterre, Pierre-François</creatorcontrib><creatorcontrib>Goffette, Pierre</creatorcontrib><creatorcontrib>De Reyck, Chantal</creatorcontrib><creatorcontrib>Lengelé, Benoît</creatorcontrib><creatorcontrib>Gianello, Pierre</creatorcontrib><creatorcontrib>Lerut, Jan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Wanfang Data Journals - Hong Kong</collection><collection>WANFANG Data Centre</collection><collection>Wanfang Data Journals</collection><collection>万方数据期刊 - 香港版</collection><collection>China Online Journals (COJ)</collection><collection>China Online Journals (COJ)</collection><jtitle>Hepatobiliary & pancreatic diseases international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Iesari, Samuele</au><au>Inostroza Núñez, Milton Eduardo</au><au>Rico Juri, Juan Manuel</au><au>Ciccarelli, Olga</au><au>Bonaccorsi-Riani, Eliano</au><au>Coubeau, Laurent</au><au>Laterre, Pierre-François</au><au>Goffette, Pierre</au><au>De Reyck, Chantal</au><au>Lengelé, Benoît</au><au>Gianello, Pierre</au><au>Lerut, Jan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adult-to-adult living-donor liver transplantation: The experience of the Université catholique de Louvain</atitle><jtitle>Hepatobiliary & pancreatic diseases international</jtitle><addtitle>Hepatobiliary Pancreat Dis Int</addtitle><date>2019-04-01</date><risdate>2019</risdate><volume>18</volume><issue>2</issue><spage>132</spage><epage>142</epage><pages>132-142</pages><issn>1499-3872</issn><abstract>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.
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.
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 810 g (IQR 730–940) and 454 g (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% (right) vs. 84% and 58% (left), respectively. One- and 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 IIIa, 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.
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.</abstract><cop>Singapore</cop><pub>Elsevier B.V</pub><pmid>30850341</pmid><doi>10.1016/j.hbpd.2019.02.007</doi><tpages>11</tpages></addata></record> |
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| ispartof | Hepatobiliary & pancreatic diseases international, 2019-04, Vol.18 (2), p.132-142 |
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| source | Elsevier ScienceDirect Journals Complete - AutoHoldings; MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adult Age Factors Belgium Cohort Studies Female Graft Rejection Graft Survival Hepatectomy - methods Hepatocellular cancer Hospitals, University Humans Liver Failure - surgery Liver Neoplasms - surgery Liver transplantation Liver Transplantation - methods Liver Transplantation - mortality Living Donors Living-donor Male Middle Aged Prognosis Retrospective Studies Risk Assessment Secondary liver tumor Small-for-size graft Small-for-size syndrome Survival Analysis Transplant Recipients Treatment Outcome |
| title | Adult-to-adult living-donor liver transplantation: The experience of the Université catholique de Louvain |
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