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| Adult-to-adult living-donor liver transplantation: The experience of the Universitécatholique de Louvain |
| Samuele Iesari a , b , Milton Eduardo Inostroza Núñez c , Juan Manuel Rico Juri d , Olga Ciccarelli a , Eliano Bonaccorsi-Riani a , Laurent Coubeau a , Pierre-François Laterre e , Pierre Goffette f , Chantal De Reyck a , Benoît Lengelé g , Pierre Gianello h , Jan Lerut a , ∗ |
a Starzl Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Universitécatholique de Louvain, Avenue Hippocrates 10, 1200 Brussels, Belgium
b Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
c Hepatobiliopancreatic Unit, Las Higueras Hospital, Talcahuano, Chile
d Cirugía de Trasplantes, Centro Médico Imbanaco, Cali, Colombia
e Department of Intensive Care, Cliniques Universitaires Saint-Luc, Universitécatholique de Louvain, Brussels, Belgium
f Department of Radiology, Cliniques Universitaires Saint-Luc, Universitécatholique de Louvain, Brussels, Belgium
g Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, Universitécatholique de Louvain, Brussels, Belgium
h Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Universitécatholique de Louvain, Brussels, Belgium
∗ Corresponding author.
E-mail address: jan.lerut@uclouvain.be (J. Lerut). |
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Abstract 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 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.
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.
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2019, Vol. 18 
