Single center analysis of the first 304 living donor liver transplantations in 3 years

Abstract

Background/Aims: Living donor liver transplantations (LDLT) has been established as an excellent treatment method for patients with end-stage liver disease and has achieved exponential growth, especially in the countries that have the donation problem. Between April 2007 and April 2010, we performed LDLT in 289 patients. Fifteen of the cases required re-transplantations. In the present study, these 304 consecutive LDLTs were evaluated to determine both donor and recipient outcomes. Methodology: Complication rates and survival data of the recipients and donors of 304 LDLT cases were analyzed. Results: All donors were alive and well. Overall complication rate was 27% (83 donors). These complications included bile leakage in 2%, intraabdominal bleeding in 2%, chylous peritonitis in 0.6%, hepatic venous obstruction due to not performing falsiformepexia in 0.3%, wound infection in 11%, incisional henia in 2%, and pulmonar complications (atelectasia, pneumonia) in 8%. The recipient complication rate was 51% in early postoperative period. The most frequent complication was infections. Five patients died due to aggressive infections. In the long term there were 57 biliary stricture cases. Five patients had chronic bile fistula. Hepaticojejunostomies were performed in 13 patients. Endoscopic stents were placed in 20 cases. Twenty-four patients were managed by percutaneous biliary catheter. Chronic and acute rejection attacks developed in 7 and 103 patients respectively. Hepatic artery thrombosis developed in 25 patients (8%). The mean follow-up was 19 months. One, two and three year survival rates were 82%, 79% and 75% respectively. In hospital mortality rate was 16%. There were a total of 74 (25%) recipient mortalities along follow up period due to 15 vascular complications, 39 septic complications, 9 liver dysfunctions, 6 chronic rejections and 5 different causes. Conclusions: More than 150 liver tranplantations per year in a single center is a challenge in Turkey, where there is a shortage of deceased donor grafts. LDLT is a safe procedure for the donors and an effective therapy for the patients with end-stage liver diseases. We believe that with accumulation of experience in surgery and clinical management, better outcomes of LDLT can be expected.