- Email: [email protected]
Dual-graft living donor liver transplantation: An innovative surgical procedure for live liver donor pool expansion
e20
Electronic Poster Abstracts
FP03-04 DUAL-GRAFT LIVING DONOR LIVER TRANSPLANTATION: AN INNOVATIVE SURGICAL PROCEDURE FOR LIVE LIVER DONOR POOL EXPANSION G. -W. Song, S. -G. Lee, C. -S. Ahn, D. -B. Moon, S. Hwang, K. -H. Kim, T. -Y. Ha, D. -H. Jung, G. -C. Park and M. J. Jeong Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea Introduction: To detail the surgical technique and outcomes of dual-graft (DG) adult living donor liver transplantation (ALDLT). Background: DG ALDLT has a great potential for expanding the living donor pool without increasing donor risk. However, little is known about DG ALDLT because it has been performed by a limited number of institutions due to its technical complexity. Methods: The clinical data of patients who underwent DG ALDLT at a single institute between March 2000 and December 2014 were retrospectively reviewed. Results: In total, 400 DG ALDLTs, which accounted for 11.7% of all ALDLTs (n = 3387), were performed at our institute. The 1-, 5-, and 10-year patient survival rates of DG ALDLT were 89.2%, 84.0%, and 80.2%, respectively, which were not statistically different from those of singlegraft ALDLT (P = 0.060). In a propensity-matched cohort, there were no significant differences in the survival outcomes. Donor age, body mass index, and steatosis were significantly higher in the DG group. Additionally, the male predominance in the gender ratio of donors was lower in the DG group. In the DG group, the mean operative time was longer (18.7 vs 13.9 hours, P < 0.001) and there was greater requirement for intraoperative transfusion of red blood cells (18.2 vs 11.4 units, P < 0.001). Additionally, the surgical complication rate per patient was significantly higher (28.5% vs 53.7%, P < 0.001). Conclusions: DG ALDLT enables us to achieve an acceptable survival outcome with 2 suboptimal grafts. However, its technical complexity and longer operative time limit its widespread application.
FP03-05 OUTCOMES OF 2739 LIVING DONOR LIVER TRANSPLANTATION WITHOUT A DISEASED DONOR BACK UP: INSIGHT AND LESSONS TO BE LEARNED I. Marwan1, M. Elmeteni2, A. Hosny3, K. Aamer4, M. Amin5 and M. Abd El-Wahab6 1 Hepato-biliary Surgery, Menoufeya University, National Liver Institute, 2Ain Shams University, 3Cairo University, 4 Militery Academy, Faculty of Medicine, 5Melitary Academy, Maadi Hospital, and 6Mansoura University, Gastroenterology Surgical Center, Egypt Introduction: Living donor liver transplantation (LDLT) is established therapy for end stage liver diseases when deceased donor (DD) is not a viable alternative. We present the outcomes, and discuss lessons learned from our experience in Egypt.
Methods: Between August 2001 to August 2015, 2739 LDLT cases were performed, adults represented 94.23% with mean age 55.7 years while 5.77% were pediatric with mean age 6.7 years. Main indication in adults was HCV cirrhosis 93% with or without hepato-cellular carcinoma [HCC] with mean MELD score 18. HCC cases were 28.5% and 86% of them were within Milan criteria. In pediatrics, biliary atresia was 55%. A single case with hepatoblastoma. Results: Operative mortality was 1%, donor mortality was five (0.18%). Major morbidity of hepatic insufficiency requiring LDLT two weeks post donation. Adult mortality was 32% versus 22.7% for the pediatrics. Biliary complications amounted 25%. Recipients with HCC, 1st year recurrence was 11%, 3 years recurrence was 17%, five year survival was 55% and mortality due to tumor recurrence was 14%. Hepatoblastoma case is doing well recurrencefree for 10 years. Lessons learned from our experience are: liver biopsy for donors and remaining liver volume not less than 35%. Conclusion: LDLT is a potentially safe procedure when DD is not available. The long term and disease free survival in HCC cases received LDLT is comparable with those using diseased donors. Although LDLT had reasonable outcomes; yet, it carries considerable risks to healthy donors, lacks cadaveric back up and is not feasible for all patients.
FP03-06 OUTCOME OF RITUXIMAB-BASED DESENSITIZATION PROTOCOL WITHOUT LOCAL INFUSION THERAPY FOR ABO INCOMPATIBLE LIVING DONOR LIVER TRANSPLANTATION AT SINGLE CENTER EXPERIENCE K. -W. Lee, T. Murokawa, K. -C. Yoon, S. -K. Hong, H. -S. Kim, H. Kim, N. -J. Yi and K. -S. Suh General Surgery, Seoul National University College of Medicine, Republic of Korea Objective: To evaluate feasibility of Rituximab (Rit) based protocol without local infusion for ABO incompatible (ABO-i) Living donor liver transplantation (LDLT). Method: Between March 2012 and August 2015, 33 cases (11.7%) of ABO-i LDLT were performed in our center. Our protocol is Rit (300mg/m2) around 3weeks (range: 4e33 days) before LDLT, followed by serial plasma exchange. Simultaneous splenectomy with intra- and post- operative high dose (0.8g/Kg) intravenous immunoglobulin was selectively added to 9 cases (27%). The immunosuppression was maintained with Tacrolimus, Steroids and Mycophenolate Mofetil. We retrospectively reviewed outcomes and complications. Result: One patient was excluded from this study because of early in-hospital death. The median follow-up period was 15.2 month (0.5e41.2). The 1- and 3- year graft/patient survival were 100%/100% and 75.5%/ 85.0%, respectively. We lost two patients due to chronic rejection and cancer- related death. One patient underwent re-transplantation from cadaveric donor for intractable hyper bilirubinemia even after proper biliary drainage. There was no acute antibody mediated rejection HPB 2016, 18 (S1), e1ee384
Electronic Poster Abstracts
FP03-04 DUAL-GRAFT LIVING DONOR LIVER TRANSPLANTATION: AN INNOVATIVE SURGICAL PROCEDURE FOR LIVE LIVER DONOR POOL EXPANSION G. -W. Song, S. -G. Lee, C. -S. Ahn, D. -B. Moon, S. Hwang, K. -H. Kim, T. -Y. Ha, D. -H. Jung, G. -C. Park and M. J. Jeong Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea Introduction: To detail the surgical technique and outcomes of dual-graft (DG) adult living donor liver transplantation (ALDLT). Background: DG ALDLT has a great potential for expanding the living donor pool without increasing donor risk. However, little is known about DG ALDLT because it has been performed by a limited number of institutions due to its technical complexity. Methods: The clinical data of patients who underwent DG ALDLT at a single institute between March 2000 and December 2014 were retrospectively reviewed. Results: In total, 400 DG ALDLTs, which accounted for 11.7% of all ALDLTs (n = 3387), were performed at our institute. The 1-, 5-, and 10-year patient survival rates of DG ALDLT were 89.2%, 84.0%, and 80.2%, respectively, which were not statistically different from those of singlegraft ALDLT (P = 0.060). In a propensity-matched cohort, there were no significant differences in the survival outcomes. Donor age, body mass index, and steatosis were significantly higher in the DG group. Additionally, the male predominance in the gender ratio of donors was lower in the DG group. In the DG group, the mean operative time was longer (18.7 vs 13.9 hours, P < 0.001) and there was greater requirement for intraoperative transfusion of red blood cells (18.2 vs 11.4 units, P < 0.001). Additionally, the surgical complication rate per patient was significantly higher (28.5% vs 53.7%, P < 0.001). Conclusions: DG ALDLT enables us to achieve an acceptable survival outcome with 2 suboptimal grafts. However, its technical complexity and longer operative time limit its widespread application.
FP03-05 OUTCOMES OF 2739 LIVING DONOR LIVER TRANSPLANTATION WITHOUT A DISEASED DONOR BACK UP: INSIGHT AND LESSONS TO BE LEARNED I. Marwan1, M. Elmeteni2, A. Hosny3, K. Aamer4, M. Amin5 and M. Abd El-Wahab6 1 Hepato-biliary Surgery, Menoufeya University, National Liver Institute, 2Ain Shams University, 3Cairo University, 4 Militery Academy, Faculty of Medicine, 5Melitary Academy, Maadi Hospital, and 6Mansoura University, Gastroenterology Surgical Center, Egypt Introduction: Living donor liver transplantation (LDLT) is established therapy for end stage liver diseases when deceased donor (DD) is not a viable alternative. We present the outcomes, and discuss lessons learned from our experience in Egypt.
Methods: Between August 2001 to August 2015, 2739 LDLT cases were performed, adults represented 94.23% with mean age 55.7 years while 5.77% were pediatric with mean age 6.7 years. Main indication in adults was HCV cirrhosis 93% with or without hepato-cellular carcinoma [HCC] with mean MELD score 18. HCC cases were 28.5% and 86% of them were within Milan criteria. In pediatrics, biliary atresia was 55%. A single case with hepatoblastoma. Results: Operative mortality was 1%, donor mortality was five (0.18%). Major morbidity of hepatic insufficiency requiring LDLT two weeks post donation. Adult mortality was 32% versus 22.7% for the pediatrics. Biliary complications amounted 25%. Recipients with HCC, 1st year recurrence was 11%, 3 years recurrence was 17%, five year survival was 55% and mortality due to tumor recurrence was 14%. Hepatoblastoma case is doing well recurrencefree for 10 years. Lessons learned from our experience are: liver biopsy for donors and remaining liver volume not less than 35%. Conclusion: LDLT is a potentially safe procedure when DD is not available. The long term and disease free survival in HCC cases received LDLT is comparable with those using diseased donors. Although LDLT had reasonable outcomes; yet, it carries considerable risks to healthy donors, lacks cadaveric back up and is not feasible for all patients.
FP03-06 OUTCOME OF RITUXIMAB-BASED DESENSITIZATION PROTOCOL WITHOUT LOCAL INFUSION THERAPY FOR ABO INCOMPATIBLE LIVING DONOR LIVER TRANSPLANTATION AT SINGLE CENTER EXPERIENCE K. -W. Lee, T. Murokawa, K. -C. Yoon, S. -K. Hong, H. -S. Kim, H. Kim, N. -J. Yi and K. -S. Suh General Surgery, Seoul National University College of Medicine, Republic of Korea Objective: To evaluate feasibility of Rituximab (Rit) based protocol without local infusion for ABO incompatible (ABO-i) Living donor liver transplantation (LDLT). Method: Between March 2012 and August 2015, 33 cases (11.7%) of ABO-i LDLT were performed in our center. Our protocol is Rit (300mg/m2) around 3weeks (range: 4e33 days) before LDLT, followed by serial plasma exchange. Simultaneous splenectomy with intra- and post- operative high dose (0.8g/Kg) intravenous immunoglobulin was selectively added to 9 cases (27%). The immunosuppression was maintained with Tacrolimus, Steroids and Mycophenolate Mofetil. We retrospectively reviewed outcomes and complications. Result: One patient was excluded from this study because of early in-hospital death. The median follow-up period was 15.2 month (0.5e41.2). The 1- and 3- year graft/patient survival were 100%/100% and 75.5%/ 85.0%, respectively. We lost two patients due to chronic rejection and cancer- related death. One patient underwent re-transplantation from cadaveric donor for intractable hyper bilirubinemia even after proper biliary drainage. There was no acute antibody mediated rejection HPB 2016, 18 (S1), e1ee384