Abstract:
Background. Right-lobe living-donor liver transplantation (RLDLT) is an excellent
option to reduce donor shortages for adult patients with acute liver failure (ALF). The aim
of this study was to evaluate the etiologies and outcomes of 30 consecutive adult patients
who underwent emergency RLDLT for ALF.
Methods. Between January 2007 and September 2011, we examined data from medical
records of patients with ALF who underwent RLDLT.
Results. Their mean age was 32.2 13.05 years. The etiologies of ALF were acute
hepatitis B (n 11; 36.6%), hepatitis A (n 4; 13.3%), drug intoxication (n 4; 13.3%),
pregnancy (n 2; 6.7%), hepatitis B with pregnancy (n 1; 3.3%), mushroom intoxication
(n 1; 3.3%), and unknown (n 7; 23.3%). The mean hepatic coma grade (Model for
End-Stage Liver Disease score) was 34.13 8.72. The 43 (48.7%) postoperative
complications were minor (grades I–II) and 44 (51.3%) were major (grades III–V).
Reoperation was required in 14 of 30 (47%) recipients (grades IIIb–IVa). Deaths occurred
owing to pulmonary (n 2), cardiac (n 1), septic (n 2), or encephalopathic (n 4)
complications. The mean durations of intensive care unit stay and postoperative hospitalization
were 3.2 2.3 and 29.5 23 days, respectively. The survival rate was 70%. The
mean follow-up duration was 305 days (range, 1–1582).
Conclusion. Liver transplantation is potentially the only curative modality, markedly
improving the prognosis of patients with ALF. The interval between ALF onset and death
is short and crucial because of the rapid, progressive multiorgan failure. Thus, RLDLT
should be considered to be a life-saving procedure for adult patients with ALF, requiring
quicker access to a deceased-donor liver graft and a short ischemia time.
