Adult-to-adult living-donor liver transplantation: Towards a prediction of three-month survival combining graft-to-recipient weight and meld in a caucasian population

Iesari, Samuele;Reding, Raymond;Lerut, Jan;Bonaccorsi Riani, Eliano;Ciccarelli, Olga;et.al.
(2019) 2019 American Transplant Congress, ATC 2019 — Location: Boston, MA,United States (1.June.2019)

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Purpose: Adult-to-adult living-donor LT(AALDLT) has been proposed to alleviate allograft shortage. However, it is not commonly considered in Western countries due to easier access to deceased donation, when compared to Eastern countries, and sometimes risky graft-to-recipient body weight ratio (GRBWR). We hypothesized that a priori computation of MELD status and GRBWR might predict LT outcome. Methods: Between 1998 and October 2018 a total of 68 AALDLT were performed at our Centre. Main indications were primary (23/68, 33. 8%) and secondaty (12/68, 17. 6%)liver tumours, cholestatic liver disease (13/68, 19. 1%∗ and alcoholic cirrhosis 10/68(14. 7). The median MELDwas 11 (interquartilerange, IQR7-16). After donor medical and liver volume assessment using MeVis software, 28/68 (41. 2%) liver donors underwent full left and 40/68 cases (58. 8%) right hepatectomy. The median GRBWR was 0. 99% (IQR 0. 78-1. 21%). Results: Overall 3-month patient and graft survivals were 85% and 79%. Retrans-plantationratewas 12% Causes of mortality were: sepsis (4/10, 40%), sudden cardiac arrest (2/10, 20%), multi-organ failure (3/10, 30%), coeliac trunk dissection with sub-sequent bleeding (1/10, 10%). Indications for retransplantation were: hepatic artery thrombosis (2/8, 25%), portal vein thrombosis (2/8, 25%), small-for-size syndrome (2/8, 250/c), graft failure after caval thrombosis (1/8, 12. 5%), massive bleeding from hepatic artery (1/8, 12. 5%). Patients were categorized retrospectively with respect to their MELD status (<15 vs. >15), as well as to their GRBWR (<0. 8% vs. >0. 8%). Four sub-groups of recipients were identified accordingly, with their respective 3-month patient deathrate: group 1 (MELD<15; GRBWRO. 8): 1/13 (7. 7%); group 2 (MELD<15; GRBWR >0. 8): 2/31 (6. 5%); group 3 (MELD>15; GRBWR<0. 8): 1/4 (25. 0%); group 4 (MELD>15; GRBWR >0. 8) 6/20 (30. 0%). The difference in the death rate was statisticalh/significant only for group 2 vs. group 4 (p=0. 045). Conclusions: Regardless of graft size, the severity liver disease seemed, in this work. to constitute the prominent predictor of 3-month outcome after AALDLT. In high MELD patients, additional strategies (portal vein modulation including porto-caval shunt) and staged RAPID techniques might be considered.
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Iesari, S., Reding, R., Lerut, J., Bonaccorsi Riani, E., Coubeau, L., & Ciccarelli, O. (2019). Adult-to-adult living-donor liver transplantation: Towards a prediction of three-month survival combining graft-to-recipient weight and meld in a caucasian population. American Journal of Transplantation. Supplement, 3, 879. https://doi.org/10.1111/ajt.15406 (Original work published 2019)