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Left-liver Adult-to-Adult Living Donor Liver Transplantation

Can It Be Improved? A Retrospective Multicenter European Study

Sánchez-Cabús, Santiago, MD, PhD*; Cherqui, Daniel, MD; Rashidian, Niki, MD; Pittau, Gabriella, MD; Elkrief, Laure, MD§; Vanlander, Aude, MD; Toso, Christian, MD, PhD§; Fondevila, Constantino, MD, PhD*; Cunha, Antonio Sa, MD; Berney, Thierry, MD, MSc§; Castaing, Denis, MD; de Hemptinne, Bernard, MD; Fuster, Josep, MD, PhD*; Rogiers, Xavier, MD, PhD; Adam, René, MD, PhD; Majno, Pietro, MD, PhD§; García-Valdecasas, Juan Carlos, MD, PhD*; Troisi, Roberto I., MSc, MD, PhD, FEBS‡,¶

doi: 10.1097/SLA.0000000000002897
ESA PAPERS

Objective: To evaluate the European experience after Adult-to-adult living donor liver transplantation using the left liver (LL-aLDLT).

Summary Background Data: LL-aLDLT decreases donor risk but provides a smaller graft that increases recipient risk as compared with right liver (RL-aLDLT). However, there is little knowledge of results obtained after LL-aLDLT in Europe.

Methods: This is a European multicenter retrospective study which aims to analyze donor and recipient outcomes after 46 LL-aLDLT.

Results: Seventy-six percent of the grafts were harvested by minimally invasive approach. Mean donor hospital stay was 7.5 ± 3.5 days. Donor liver function was minimally impaired, with 36 donors (78.3%) without any 90-day complication, and 4 (8.7%) presenting major complications. One, 3, and 5-year recipient survival was 90.9%, 82.7%, and 82.7%, respectively. However, graft survival was of 59.4%, 56.9%, and 56.9% at 1, 3, and 5 years respectively, due to a 26.1% urgent liver retransplantation (ReLT) rate, mainly due to SFSS (n = 5) and hepatic artery thrombosis (HAT, n = 5). Risk factor analysis for ReLT and HAT showed an association with a graft to body weight ratio (GBWR) <0.6% (P = 0.01 and P = 0.024, respectively) while SFSS was associated with a recipient MELD ≥14 (P = 0.019). A combination of donor age <45 years, MELD <14 and actual GBWR >0.6% was associated with a lower ReLT rate (0% vs. 33%, P = 0.044).

Conclusions: Our analysis showed low donor morbidity and preserved liver function. Recipient outcomes, however, were hampered by a high ReLT rate. A strict selection of both donor and recipients is the key to minimize graft loss.

*Department of HPB Surgery and Transplantation, Hospital Clínic de Barcelona. CIBEREHD. Barcelona, Spain

Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France

Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital and Medical School, Ghent, Belgium

§Division of Transplantation, Department of Surgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland

Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.

Reprints: Santiago Sánchez-Cabús, MD, PhD, Department of HBP Surgery and Transplantation, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain. E-mail: ssanche1@clinic.cat; Daniel Cherqui, MD, Centre Hépato-Biliaire, Hôpital Paul Brousse, 12-14 Av. Paul Vaillant Couturier, F-94800 Villejuif, France. E-mail: Daniel.cherqui@aphp.fr.

This work has not been supported by any external financing, i.e., grant, equipment, or drug.

The authors report no conflicts of interest.

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