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Using Clavien Grading System to expose early recipient' morbidity and mortality in living donor liver transplantation
Electronic Poster Abstracts diagnosed as Gilbert’s syndrome. Another 20 (30%) donors had other mutations of UGT1A1 gene. Remaining 10 (15%) donors were UGT1A1 wild type. Conclusions: In graft selection, FLR / total liver volume > 30% is suitable for safe donor liver resection. On the basis of this graft selection criteria, hyperbilirubinemia after donor liver resection had mutations of UGT1A1.
EP05B-008 INITIAL EXPERIENCES IN LAPAROSCOPIC RIGHT DONOR HEPATECTOMY A. Nugroho, K. -S. Suh and S. K. Hong Surgery, Seoul National University Hospital, Republic of Korea Background: The primary concern of donor surgery in Living Donor Liver Transplantation (LDLT) is donor safety. To push it further toward a better quality of life for the donor after surgery, the concept of laparoscopic donor hepatectomy is introduced. The aim of this study was to evaluate our initial experience in laparoscopic right donor hepatectomy. Method: Between January 1999 and February 2014, 1,000 LDLT were performed at Seoul National University Hospital. Among them, 3.9% underwent laparoscopic donor hepatectomy (37 right hemihepatectomy and 2 left lateral sectionectomy). We retrospectively analyze 37 laparoscopic right donor hepatectomy, including 7 Hand Assisted Laparoscopic Surgery (HALS) and 30 Hybrid procedure. Result: There were 29 females and 8 males, with the mean age of 25.32 6.11 years old and median BMI 26.62 (17.16e30.26) kg/m2. Hybrid procedure was associated with least estimated blood loss and shorter duration of procedure, compared to HALS (267.95 147.06 ml vs 599 352.32 ml; p = 0.02, and 328.64 min 101.09 vs 517 133.45 min; p = 0.02, respectively). There was no statistically significant difference in the length of stay between two procedures. Transverse incision was preferred for all female patients, because of good cosmetic result and no tension in scar. Postoperative complication rate was 43.2%, mainly ClavieneDindo I (40.5%). Conclusion: We consider hybrid with minimal upper midline incision as the most users friendly to start laparoscopic donor hepatectomy, because it does not need a sophisticated laparoscopic expertise.
EP05B-009 ZERO % BILLIARY STRICTURE IN MICROSCOPIC RECONSTRUCTION (MBR) OF HEBATICO-BILLIARY ROUX EN Y CHOICE OF BILLIARY DRAINAGE OF ADULT ORTHODONTIC LIVER TRANSPLANT A. Ghannam, T. -S. Lin and C. -L. Chen Liver Transplant Programme, Kaohsiung Chang Gung Memorial Hospital, Taiwan, Republic of China
HPB 2016, 18 (S1), e385ee601
e573
Introduction: There is no concensus on microscopic billiary reconstruction using Roux en Y hebatico-billiary for patient under going adult olt. Microscopic technique previously used for hebatic artery has been extended to billiary reconstruction to decrease the billiary complication. The routine use of (NBR) by Roux en Y in adult liver transplant has not been elucidated. The aim of the study is to compare long term outcome after olt with Roux en Y (MBR) with the conventional era. It is to study and evaluate the choice, application and outcome of billiary reconstruction by (MBR) Roux en Y anastamosis in adult liver transplant with comparison to the conventional Roux en Y. Method: In consecutive series of 66 patients undergoing olt with roux en y .16 cases by old conventional method (group a) up to March 2006. The other 50 cases by the recent era of (MBR) (group b ) up to June 2014. Results: There is no mortality in olt adult liver transplant related to billiary problems. This study shows the long term outcome of Roux en Y by (MBR) is better than the conventional method in adult liver transplant. group a 3 cases bile leak 2 cases stricture group b 3 cases bile leak no stricture Conclusion: In spite of the draw back of hepaticojejunostomy anastamosis we have developed graft survival in adult liver transplant with widened application of (MBR). It is technically and anatomically feasible and can be performed safely in patients undergoing adult olt.
EP05B-010 USING CLAVIEN GRADING SYSTEM TO EXPOSE EARLY RECIPIENT’ MORBIDITY AND MORTALITY IN LIVING DONOR LIVER TRANSPLANTATION O. Hegazy, M. Taha, A. Sherif, E. Gad, H. Zakaria, A. Aziz, H. E. Soliman, T. Ibrahim and K. Abuella HPB and Transplant Surgery, National Liver Institute, Menoufia University, Egypt Aim: The aim of this study is to identify recipients’ complications during the first 3 months post Adult living donor liver transplantation, and to present a simple and a standardized grading system “Clavien Grading System” to grade the severity of these complications. Consequently, to compare the outcome among different centers. Methods: The Clavien Grading system was applied for 230 reciepient done in the National Liver Institute, Menoufia University, Egypt, during the period from April 2003 till April 2015. Data collection and analysis were done during the period from May to August 2015. KaplaneMeier survival curves were plotted and Log Rank test was done. Results: We reported post-operative complications during the first 3 months in 66.7% of the recipients. No grade I complications were noted. Grades II, III, IV and V
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Electronic Poster Abstracts
complications were observed in 14 recipients (6.3%), 54 recipients (23.6%), 9 recipients (4% ) and 75 recipients (32.8%), respectively. Those complications included biliary (20.7%), vascular (12.1%), graft complications [small for size, acute rejection] (12.6%), and other surgical and medical complications (21.3%). KaplaneMeier survival curves were plotted and Log Rank test was done. The test result was significant with p-value less than 0.05. Conclusion: Clavien Grading System was efficiently useful in summarizing the outcome of Adult living donor liver transplantation recipients. It also provides a simple disclosure of data and a helping tool in comparing different centers aiming at improving the outcomes.
EP05B-011 MULTIPLE BILE DUCTS: DO THE DUCT DISTANCE AND THE NUMBER OF BILIARY ANASTOMOSIS HAVE AN IMPACT ON THE RECIPIENT’S BILIARY PROBLEMS? K. C. Yoon, S. K. Hong, H. -S. Kim, H. Kim, N. -J. Yi, K. -W. Lee and K. S. Suh Department of Surgery, Seoul National University Hospital, Republic of Korea Introduction: The variation of multiple bile ducts in a living donor graft can be encountered frequently but whether or not this leads to biliary complications has not been known yet. Especially a duct distance between the bile duct and the number of biliary anastomosis has not been known to the risk of the recipient’s complication. Method: From 316 patients who underwent living donor liver transplantation from 2011 to 2013, a total of 55 patients had more than 2 bile duct openings. Result: Forty-seven patients had 2 openings while 3 patients had 3 openings. Duct to duct anastomosis was done in 46 patients and 25 had tailored telescope reconstruction (TTR) while 29 patients had 1 or 2 internal stents placed. The average distance between the ducts was 5.8 mm. 25 patients were performed one biliary anastomosis using TTR method. Duct complication was not increased when the distance between ducts was longer. And the number of biliary anastomosis does not impact on complication. Conclusion: 8 patients from a total of 50 patients developed biliary complications showing a complication rate of 16%, which is not significantly high compared with complication rates with 1 duct opening in other articles. In the 2 bile duct group, duct distances is not significant that the longer distance between the ducts does not cause the worse outcomes as most would tend to expect. And TTR method could make one biliary anastomosis and it seems beneficial effect in small distance between the ducts.
EP05B-013 SYSTEMATIC REVIEW AND METAANALYSIS OF GRAFT RECIPIENT WEIGHT RATIO AND IMPACT ON SMALL FOR SIZE SYNDROME, PERIOPERATIVE OUTCOMES AND SURVIVAL IN LIVING DONOR LIVER TRANSPLANTATION R. Bell1, S. Pandanaboyana2, S. Nisar1, K. Gurusamy3 and R. Prasad1 1 Department of Hepatobiliary and Transplant Surgery, St James’ University Hospital, United Kingdom, 2Department of Hepatobiliary and Transplant Surgery, Auckland City Hospital, New Zealand, and 3UCL Medical School, Royal Free Hospital, United Kingdom Introduction: This meta-analysis aimed to compare living donor liver transplant (LDLT) grafts with a graft recipient weight ratio (GRWR) of <0.8 to grafts with a GRWR 0.8 with regards to small-for-size syndrome (SFSS) and short and longer-term outcomes. Method: An electronic search was performed of the MEDLINE, EMBASE and PubMed databases until June 2015 using both subject headings (MeSH) and free text. Pooled odds ratios (OR) and hazard ratios (HR) were calculated using fixed- and random-effects models for meta-analysis. Results: Seven studies including 1641 patients met the inclusion criteria. The rate of SFSS was 10% in the <0.8 group and 4.4% in the 0.8 group OR 2.19 (1.14, 4.19) (p = 0.020). No significant difference was noted between the 2 groups with regards to graft survival up to 5-years HR 1.31 (0.88, 1.94) (p = 0.190). Similarly no significant difference was noted in overall complications (p = 0.06), biliary (p = 0.290) or vascular complications (p = 0.190), perioperative haemorrhage (p = 0.150), postoperative mortality (p = 0.810) and rejection (p = 0.160). Conclusion: There is a higher incidence of SFSS in grafts with a GRWR <0.8 than grafts 0.8, however there is no evidence of any impact on perioperative outcomes and graft survival.
EP05B-014 EVALUATION OF SURGICAL COMPLICATIONS IN 204 LIVE LIVER DONORS ACCORDING TO MODIFIED CLAVIEN’S SYSTEM: NATIONAL LIVER INSTITUTE EXPERIENCE A. Mostafa Aziz, K. Abou Alla, S. Saleh, O. Hegazy, M. Taha, E. Hamdy Salem and H. Zakaria HPB and Liver Transplant Surgery, National Liver Institute, Menoufia University, Egypt Background: Several large centers have reported outstanding outcomes of LDLT to decrease waiting list mortality. Although the ratio of complications differ widely, Moreover, there is still no consensus on how to define and stratify complications by severity.
HPB 2016, 18 (S1), e385ee601
EP05B-008 INITIAL EXPERIENCES IN LAPAROSCOPIC RIGHT DONOR HEPATECTOMY A. Nugroho, K. -S. Suh and S. K. Hong Surgery, Seoul National University Hospital, Republic of Korea Background: The primary concern of donor surgery in Living Donor Liver Transplantation (LDLT) is donor safety. To push it further toward a better quality of life for the donor after surgery, the concept of laparoscopic donor hepatectomy is introduced. The aim of this study was to evaluate our initial experience in laparoscopic right donor hepatectomy. Method: Between January 1999 and February 2014, 1,000 LDLT were performed at Seoul National University Hospital. Among them, 3.9% underwent laparoscopic donor hepatectomy (37 right hemihepatectomy and 2 left lateral sectionectomy). We retrospectively analyze 37 laparoscopic right donor hepatectomy, including 7 Hand Assisted Laparoscopic Surgery (HALS) and 30 Hybrid procedure. Result: There were 29 females and 8 males, with the mean age of 25.32 6.11 years old and median BMI 26.62 (17.16e30.26) kg/m2. Hybrid procedure was associated with least estimated blood loss and shorter duration of procedure, compared to HALS (267.95 147.06 ml vs 599 352.32 ml; p = 0.02, and 328.64 min 101.09 vs 517 133.45 min; p = 0.02, respectively). There was no statistically significant difference in the length of stay between two procedures. Transverse incision was preferred for all female patients, because of good cosmetic result and no tension in scar. Postoperative complication rate was 43.2%, mainly ClavieneDindo I (40.5%). Conclusion: We consider hybrid with minimal upper midline incision as the most users friendly to start laparoscopic donor hepatectomy, because it does not need a sophisticated laparoscopic expertise.
EP05B-009 ZERO % BILLIARY STRICTURE IN MICROSCOPIC RECONSTRUCTION (MBR) OF HEBATICO-BILLIARY ROUX EN Y CHOICE OF BILLIARY DRAINAGE OF ADULT ORTHODONTIC LIVER TRANSPLANT A. Ghannam, T. -S. Lin and C. -L. Chen Liver Transplant Programme, Kaohsiung Chang Gung Memorial Hospital, Taiwan, Republic of China
HPB 2016, 18 (S1), e385ee601
e573
Introduction: There is no concensus on microscopic billiary reconstruction using Roux en Y hebatico-billiary for patient under going adult olt. Microscopic technique previously used for hebatic artery has been extended to billiary reconstruction to decrease the billiary complication. The routine use of (NBR) by Roux en Y in adult liver transplant has not been elucidated. The aim of the study is to compare long term outcome after olt with Roux en Y (MBR) with the conventional era. It is to study and evaluate the choice, application and outcome of billiary reconstruction by (MBR) Roux en Y anastamosis in adult liver transplant with comparison to the conventional Roux en Y. Method: In consecutive series of 66 patients undergoing olt with roux en y .16 cases by old conventional method (group a) up to March 2006. The other 50 cases by the recent era of (MBR) (group b ) up to June 2014. Results: There is no mortality in olt adult liver transplant related to billiary problems. This study shows the long term outcome of Roux en Y by (MBR) is better than the conventional method in adult liver transplant. group a 3 cases bile leak 2 cases stricture group b 3 cases bile leak no stricture Conclusion: In spite of the draw back of hepaticojejunostomy anastamosis we have developed graft survival in adult liver transplant with widened application of (MBR). It is technically and anatomically feasible and can be performed safely in patients undergoing adult olt.
EP05B-010 USING CLAVIEN GRADING SYSTEM TO EXPOSE EARLY RECIPIENT’ MORBIDITY AND MORTALITY IN LIVING DONOR LIVER TRANSPLANTATION O. Hegazy, M. Taha, A. Sherif, E. Gad, H. Zakaria, A. Aziz, H. E. Soliman, T. Ibrahim and K. Abuella HPB and Transplant Surgery, National Liver Institute, Menoufia University, Egypt Aim: The aim of this study is to identify recipients’ complications during the first 3 months post Adult living donor liver transplantation, and to present a simple and a standardized grading system “Clavien Grading System” to grade the severity of these complications. Consequently, to compare the outcome among different centers. Methods: The Clavien Grading system was applied for 230 reciepient done in the National Liver Institute, Menoufia University, Egypt, during the period from April 2003 till April 2015. Data collection and analysis were done during the period from May to August 2015. KaplaneMeier survival curves were plotted and Log Rank test was done. Results: We reported post-operative complications during the first 3 months in 66.7% of the recipients. No grade I complications were noted. Grades II, III, IV and V
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Electronic Poster Abstracts
complications were observed in 14 recipients (6.3%), 54 recipients (23.6%), 9 recipients (4% ) and 75 recipients (32.8%), respectively. Those complications included biliary (20.7%), vascular (12.1%), graft complications [small for size, acute rejection] (12.6%), and other surgical and medical complications (21.3%). KaplaneMeier survival curves were plotted and Log Rank test was done. The test result was significant with p-value less than 0.05. Conclusion: Clavien Grading System was efficiently useful in summarizing the outcome of Adult living donor liver transplantation recipients. It also provides a simple disclosure of data and a helping tool in comparing different centers aiming at improving the outcomes.
EP05B-011 MULTIPLE BILE DUCTS: DO THE DUCT DISTANCE AND THE NUMBER OF BILIARY ANASTOMOSIS HAVE AN IMPACT ON THE RECIPIENT’S BILIARY PROBLEMS? K. C. Yoon, S. K. Hong, H. -S. Kim, H. Kim, N. -J. Yi, K. -W. Lee and K. S. Suh Department of Surgery, Seoul National University Hospital, Republic of Korea Introduction: The variation of multiple bile ducts in a living donor graft can be encountered frequently but whether or not this leads to biliary complications has not been known yet. Especially a duct distance between the bile duct and the number of biliary anastomosis has not been known to the risk of the recipient’s complication. Method: From 316 patients who underwent living donor liver transplantation from 2011 to 2013, a total of 55 patients had more than 2 bile duct openings. Result: Forty-seven patients had 2 openings while 3 patients had 3 openings. Duct to duct anastomosis was done in 46 patients and 25 had tailored telescope reconstruction (TTR) while 29 patients had 1 or 2 internal stents placed. The average distance between the ducts was 5.8 mm. 25 patients were performed one biliary anastomosis using TTR method. Duct complication was not increased when the distance between ducts was longer. And the number of biliary anastomosis does not impact on complication. Conclusion: 8 patients from a total of 50 patients developed biliary complications showing a complication rate of 16%, which is not significantly high compared with complication rates with 1 duct opening in other articles. In the 2 bile duct group, duct distances is not significant that the longer distance between the ducts does not cause the worse outcomes as most would tend to expect. And TTR method could make one biliary anastomosis and it seems beneficial effect in small distance between the ducts.
EP05B-013 SYSTEMATIC REVIEW AND METAANALYSIS OF GRAFT RECIPIENT WEIGHT RATIO AND IMPACT ON SMALL FOR SIZE SYNDROME, PERIOPERATIVE OUTCOMES AND SURVIVAL IN LIVING DONOR LIVER TRANSPLANTATION R. Bell1, S. Pandanaboyana2, S. Nisar1, K. Gurusamy3 and R. Prasad1 1 Department of Hepatobiliary and Transplant Surgery, St James’ University Hospital, United Kingdom, 2Department of Hepatobiliary and Transplant Surgery, Auckland City Hospital, New Zealand, and 3UCL Medical School, Royal Free Hospital, United Kingdom Introduction: This meta-analysis aimed to compare living donor liver transplant (LDLT) grafts with a graft recipient weight ratio (GRWR) of <0.8 to grafts with a GRWR 0.8 with regards to small-for-size syndrome (SFSS) and short and longer-term outcomes. Method: An electronic search was performed of the MEDLINE, EMBASE and PubMed databases until June 2015 using both subject headings (MeSH) and free text. Pooled odds ratios (OR) and hazard ratios (HR) were calculated using fixed- and random-effects models for meta-analysis. Results: Seven studies including 1641 patients met the inclusion criteria. The rate of SFSS was 10% in the <0.8 group and 4.4% in the 0.8 group OR 2.19 (1.14, 4.19) (p = 0.020). No significant difference was noted between the 2 groups with regards to graft survival up to 5-years HR 1.31 (0.88, 1.94) (p = 0.190). Similarly no significant difference was noted in overall complications (p = 0.06), biliary (p = 0.290) or vascular complications (p = 0.190), perioperative haemorrhage (p = 0.150), postoperative mortality (p = 0.810) and rejection (p = 0.160). Conclusion: There is a higher incidence of SFSS in grafts with a GRWR <0.8 than grafts 0.8, however there is no evidence of any impact on perioperative outcomes and graft survival.
EP05B-014 EVALUATION OF SURGICAL COMPLICATIONS IN 204 LIVE LIVER DONORS ACCORDING TO MODIFIED CLAVIEN’S SYSTEM: NATIONAL LIVER INSTITUTE EXPERIENCE A. Mostafa Aziz, K. Abou Alla, S. Saleh, O. Hegazy, M. Taha, E. Hamdy Salem and H. Zakaria HPB and Liver Transplant Surgery, National Liver Institute, Menoufia University, Egypt Background: Several large centers have reported outstanding outcomes of LDLT to decrease waiting list mortality. Although the ratio of complications differ widely, Moreover, there is still no consensus on how to define and stratify complications by severity.
HPB 2016, 18 (S1), e385ee601