Expanding living donor liver transplantation: Report of first US living donor liver transplant chain

Background: This study aimed to determine the association between episodic or persistent hematuria after liver transplantation and long-term renal outcomes. Methods: Patients who underwent living donor liver transplantation between July 2005 and June 2019 were recruited and divided into two groups based on the finding of microscopic or gross hematuria after transplantation. All patients were followed up from the index date until the end date in May 2020. The risks of chronic kidney disease, death, and 30% and 50% declines in estimated glomerular filtration rate (eGFR) were compared between groups. Results: A total of 295 patients underwent urinalysis for various reasons after undergoing transplantation. Hematuria was detected in 100 patients (group A) but was not present in 195 patients (group B). Compared with group B, group A had a higher risk of renal progression, including eGFR decline >50% [aHR = 3.447 (95%CI: 2.24~5.30), p < 0.001] and worse survival. In addition, patients who took non-steroidal anti-inflammatory drugs (NSAIDs) continuously for over seven days within six months before transplant surgery had high risks of rapid renal progression, including a >30% decline in eGFR [aHR = 1.572 (95%CI: 1.12~2.21), p = 0.009)]. Conclusion: Development of hematuria after surgery in patients who underwent living donor liver transplant and were exposed to NSAIDs before surgery were associated with worse long-term renal dysfunction and survival.

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Expanding Living Donor Liver Transplantation

10.1093/oso/9780197618202.003.0009 ◽

2021 ◽

pp. 214-240

Author(s):

Lainie Friedman ◽

J. Richard Thistlethwaite, Jr

Keyword(s):

Liver Transplantation ◽

Young Children ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Ethical Issues ◽

Deceased Donor ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Split Liver ◽

Donor Liver Transplant

In the 1980s in the United States (US), young children in liver failure were at proportionately greater risk of dying on the deceased donor liver transplant (DDLT) waitlist than adults because of the lack of appropriately sized grafts. This led to the development of two deceased donor liver techniques—reduced-size (trimming the graft to decrease its size) and split-liver (where one liver could provide grafts to two candidates). These developments decreased but did not eliminate waitlist mortality for young children. Split-liver DDLT paved the way for living donor liver transplantation (LDLT) in children using the lateral segments of the left lobe. Pediatric LDLT began slowly at only a few centers with successful donor and recipient results. Adult-to-adult LDLT expanded quickly despite many US programs having limited experience, low volumes, and significant donor morbidity. The ethical issues raised by the rapid expansion of adult-to-adult LDLT in the US are discussed.

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Living donor liver transplantation for hepatocellular carcinoma beyond the Milan criteria: outcome of expanded criteria in tumor size

BMC Surgery ◽

10.1186/s12893-021-01403-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hsin-Rou Liang ◽

Chia-En Hsieh ◽

Kuo-Hua Lin ◽

Chih-Jan Ko ◽

Yu-Ju Hung ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Living Donor ◽

Milan Criteria ◽

Tumor Diameter ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Living Donor Liver Transplant ◽

Expanded Criteria ◽

Donor Liver Transplant

Abstract Background The Milan criteria are the universal standard of liver transplantation for hepatocellular carcinoma (HCC). Numerous expanded criteria have shown outcomes as good as the Milan criteria. In Taiwan, living donor liver transplant (LDLT) accounts for the majority of transplantations due to organ shortages. Methods We retrospectively enrolled 155 patients who underwent LDLT for HCC from July 2005 to June 2017 and were followed up for at least 2 years. Patients beyond the Milan criteria (n = 78) were grouped as recurrent or nonrecurrent, and we established new expanded criteria based on these data. Results Patients beyond the Milan criteria with recurrence (n = 31) had a significantly larger maximal tumor diameter (4.13 ± 1.96 cm versus 6.10 ± 3.41 cm, p = 0.006) and total tumor diameter (7.19 ± 4.13 cm versus 10.21 ± 5.01 cm, p = 0.005). Therefore, we established expanded criteria involving maximal tumor diameter ≤ 6 cm and total tumor diameter < 10 cm. The 5-year survival rate of patients who met these criteria (n = 134) was 77.3%, and the 5-year recurrence rate was 20.5%; both showed no significant differences from those of the Milan criteria. Under the expanded criteria, the pool of eligible recipients was 35% larger than that of the Milan criteria. Conclusion Currently, patients with HCC who undergo LDLT can achieve good outcomes even when they are beyond the Milan criteria. Under the new expanded criteria, patients can achieve outcomes as good as those with the Milan criteria and more patients can benefit.

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Surgical aspects of pediatric liver transplantation. Living donor liver transplant program in Hungary

Orvosi Hetilap ◽

10.1556/oh.2008.28336 ◽

2008 ◽

Vol 149 (27) ◽

pp. 1271-1275 ◽

Cited By ~ 4

Author(s):

László Kóbori ◽

Zoltán Máthé ◽

János Fazakas ◽

Zsuzsanna Gerlei ◽

Attila Doros ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Transplant ◽

Living Donor ◽

Pediatric Liver Transplantation ◽

Donor Liver ◽

Transplant Program ◽

Kaplan Meier ◽

Living Donor Liver Transplant ◽

Donor Liver Transplant ◽

Surgical Aspects

A májátültetés jelenti a gyermekkori végstádiumú májbetegségek egyetlen kezelési módját. A split, majd az ezt követően kifejlesztett élő donoros májátültetés ma már rutinbeavatkozásnak számít, és a gyermekkori átültetések alapját jelentik. Az átlagos Kaplan–Meier-féle meghatározás szerinti 1, illetve 5 éves túlélés 80–90% feletti. A donormáj splittelése során két májbetegen segíthetünk. A bal oldali laterális szegmenteket általában gyermekeknek, a nagyobb jobb oldalt felnőtteknek ültetjük át. Természetesen többféle kombináció jön szóba attól függően, hogy élő donoros vagy split-, vagy redukált májátültetésről van szó. Az átültetéshez szükséges májszövet mennyisége a testsúly minimum 1%-át jelenti. A hazai több mint 340 májátültetés során 27 gyermek (14 parciális graft) májátültetéséről számolhatunk be, és elindult az élődonor-program is. Az alkalmazott technikák eredményeit és szövődményeit is figyelembe véve elmondható, hogy megfelelően szigorú kivizsgálási protokollok betartásával, a sebészi, aneszteziológiai és intenzív osztályos kezelés megfelelő szintű fejlesztésével a hazai átültetések eredményei nemzetközi szintre emelkedtek. Az utolsó 5 év átlagos túlélése 80% feletti volt.

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