nach oben

Erschienen in:

21.02.2024 | Original Article

Early Graft Failure After Living-Donor Liver Transplant

verfasst von: Ahmad Anouti, Moustafa Al Hariri, Lisa B. VanWagner, William M. Lee, Arjmand Mufti, Mark Pedersen, Jigesh Shah, Steven Hanish, Parsia A. Vagefi, Thomas G. Cotter, Madhukar S. Patel

Erschienen in: Digestive Diseases and Sciences | Ausgabe 4/2024

Einloggen, um Zugang zu erhalten

Abstract

Background

Living-donor liver transplantation (LDLT) has been increasing in the USA. While data exist on longer-term patient and graft outcomes, a contemporary analysis of short-term outcomes is needed.

Aim

Evaluate short-term (30-day) graft failure rates and identify predictors associated with these outcomes.

Methods

Adult (≥ 18) LDLT recipients from 01/2004 to 12/2021 were analyzed from the United States Scientific Registry of Transplant Recipients. Graft status at 30 days was assessed with graft failure defined as retransplantation or death. Comparison of continuous and categorical variables was performed and a multivariable logistic regression was used to identify risk factors of early graft failure.

Results

During the study period, 4544 LDLTs were performed with a graft failure rate of 3.4% (155) at 30 days. Grafts from male donors (aOR: 0.63, CI 0.44–0.89), right lobe grafts (aOR: 0.40, CI 0.27–0.61), recipients aged > 60 years (aOR: 0.52, CI 0.32–0.86), and higher recipient albumin (aOR: 0.73, CI 0.57–0.93) were associated with superior early graft outcomes, whereas Asian recipient race (vs. White; aOR: 3.75, CI 1.98–7.10) and a history of recipient PVT (aOR: 2.7, CI 1.52–4.78) were associated with inferior outcomes. LDLTs performed during the most recent 2016–2021 period (compared to 2004–2009 and 2010–2015) resulted in significantly superior outcomes (aOR: 0.45, p < 0.001).

Conclusion

Our study demonstrates that while short-term adult LDLT graft failure is uncommon, there are opportunities for optimizing outcomes by prioritizing right lobe donation, improving candidate nutritional status, and careful pre-transplant risk assessment of candidates with known PVT. Notably, a period effect exists whereby increased LDLT experience in the most recent era correlated with improved outcomes.

Graphical Abstract

Nur mit Berechtigung zugänglich

Gruessner RWG, Gruessner AC. Solid-organ transplants from living donors: cumulative united states experience on 140,156 living donor transplants over 28 years. Transplant Proc. 2018;50:3025–3035.PubMedCrossRef

Cotter TG, Sandıkçı B, Paul S et al. Liver transplantation for alcoholic hepatitis in the United States: excellent outcomes with profound temporal and geographic variation in frequency. Am J Transplant. 2021;21:1039–1055.PubMedCrossRef

Lo CM. Expanding living donor liver transplantation. Liver Transpl. 2016;22:37–39.PubMedCrossRef

Cotter TG, Paul S, Sandıkçı B et al. Improved graft survival after liver transplantation for recipients with hepatitis C virus in the direct-acting antiviral era. Liver Transpl. 2019;25:598–609.PubMedCrossRef

Goldaracena N, Barbas AS. Living donor liver transplantation. Curr Opin Organ Transplant. 2019;24:131–137.PubMedCrossRef

OPTN. O.P.a.T.N. OPTN metrics. https://optn.transplant.hrsa.gov/data/visual-dashboards/optn-metrics/. Accessed 9 Nov 2022

Kwong AJ, Ebel NH, Kim WR et al. OPTN/SRTR 2020 annual data report: liver. Am J Transplant. 2022;22:204–309.PubMedCrossRef

Cotter TG, Minhem M, Wang J et al. Living donor liver transplantation in the united states: evolution of frequency, outcomes, center volumes, and factors associated with outcomes. Liver Transpl. 2021;27:1019–1031.PubMedPubMedCentralCrossRef

Goto T, Ivanics T, Cattral MS et al. Superior long-term outcomes of adult living donor liver transplantation: a cumulative single-center cohort study with 20 years of follow-up. Liver Transpl. 2022;28:834–842.PubMedCrossRef

10.

Jackson WE, Malamon JS, Kaplan B et al. Survival benefit of living-donor liver transplant. JAMA Surg. 2022;157:926–932.PubMedPubMedCentralCrossRef

11.

Olthoff KM, Smith AR, Abecassis M et al. Defining long-term outcomes with living donor liver transplantation in North America. Ann Surg. 2015;262:465–475 (Discussion 473-465).PubMedCrossRef

12.

Kitajima T, Moonka D, Yeddula S et al. Outcomes in living donor compared with deceased donor primary liver transplantation in lower acuity patients with model for end-stage liver disease scores <30. Liver Transpl. 2021;27:971–983.PubMedCrossRef

13.

Nakamura T, Nobori S, Harada S et al. Impact of donor and recipient age on outcomes after living donor liver transplant. Transplant Proc. 2022;54:438–442.PubMedCrossRef

14.

Nitski O, Azhie A, Qazi-Arisar FA et al. Long-term mortality risk stratification of liver transplant recipients: real-time application of deep learning algorithms on longitudinal data. Lancet Digit Health. 2021;3:e295–e305.PubMedCrossRef

15.

Levitsky J, Goldberg D, Smith AR et al. Acute rejection increases risk of graft failure and death in recent liver transplant recipients. Clin Gastroenterol Hepatol. 2017;15:584-593.e582.PubMedCrossRef

16.

Idossa DW, Simonetto DA. Infectious complications and malignancies arising after liver transplantation. Anesthesiol Clin. 2017;35:381–393.PubMedCrossRef

17.

Xue Z, Zhang X, Li Z et al. Analysis of portal vein thrombosis after liver transplantation. ANZ J Surg. 2019;89:1075–1079.PubMedCrossRef

18.

Duffy JP, Hong JC, Farmer DG et al. Vascular complications of orthotopic liver transplantation: experience in more than 4200 patients. J Am Coll Surg. 2009;208:896–903 (Discussion 903-895).PubMedCrossRef

19.

Acuna SA, Zhang W, Yoon PD et al. Right lobe versus left lobe living donor liver transplantation: a systematic review and meta-analysis of donor and recipient outcomes. Transplantation. 2022;106:2370–2378.PubMedCrossRef

20.

Sudhindran S, Menon RN, Balakrishnan D. Challenges and outcome of left-lobe liver transplants in adult living donor liver transplants. J Clin Exp Hepatol. 2012;2:181–187.PubMedPubMedCentralCrossRef

21.

Herrero JI, Lucena JF, Quiroga J et al. Liver transplant recipients older than 60 years have lower survival and higher incidence of malignancy. Am J Transplant. 2003;3:1407–1412.PubMedCrossRef

22.

Avanaz A, Doğru V, Kisaoglu A et al. Impact of older age on the long-term survival in living-donor liver transplantation: a propensity score matching analysis. Asian J Surg. 2022;45:2239–2245.PubMedCrossRef

23.

Kwon JH, Yoon YI, Song GW et al. Living donor liver transplantation for patients older than age 70 years: a single-center experience. Am J Transplant. 2017;17:2890–2900.PubMedCrossRef

24.

Jalan R, Schnurr K, Mookerjee RP et al. Alterations in the functional capacity of albumin in patients with decompensated cirrhosis is associated with increased mortality. Hepatology. 2009;50:555–564.PubMedCrossRef

25.

Oettl K, Birner-Gruenberger R, Spindelboeck W et al. Oxidative albumin damage in chronic liver failure: relation to albumin binding capacity, liver dysfunction and survival. J Hepatol. 2013;59:978–983.PubMedCrossRef

26.

Domenicali M, Baldassarre M, Giannone FA et al. Posttranscriptional changes of serum albumin: clinical and prognostic significance in hospitalized patients with cirrhosis. Hepatology. 2014;60:1851–1860.PubMedCrossRef

27.

Giannone FA, Domenicali M, Baldassarre M et al. Ischaemia-modified albumin: a marker of bacterial infection in hospitalized patients with cirrhosis. Liver Int. 2015;35:2425–2432.PubMedCrossRef

28.

Baldassarre M, Domenicali M, Naldi M et al. Albumin homodimers in patients with cirrhosis: clinical and prognostic relevance of a novel identified structural alteration of the molecule. Sci Rep. 2016;6:35987.PubMedPubMedCentralCrossRef

29.

Alcaraz-Quiles J, Casulleras M, Oettl K et al. Oxidized albumin triggers a cytokine storm in leukocytes through P38 mitogen-activated protein kinase: role in systemic inflammation in decompensated cirrhosis. Hepatology. 2018;68:1937–1952.PubMedCrossRef

30.

Salerno F, Borroni G, Moser P et al. Survival and prognostic factors of cirrhotic patients with ascites: a study of 134 outpatients. Am J Gastroenterol. 1993;88:514–519.PubMed

31.

D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44:217–231.PubMedCrossRef

32.

Carvalho JR, Verdelho Machado M. New insights about albumin and liver disease. Ann Hepatol. 2018;17:547–560.PubMedCrossRef

33.

Bertelli R, Nardo B, Montalti R et al. Liver transplantation in recipients with portal vein thrombosis: experience of a single transplant center. Transplant Proc. 2005;37:1119–1121.PubMedCrossRef

34.

Park GC, Song GW, Moon DB et al. A review of current status of living donor liver transplantation. Hepatobiliary Surg Nutr. 2016;5:107–117.PubMedPubMedCentral

35.

Miura K, Sugawara Y, Uchida K et al. Adult living donor liver transplantation for patients with portal vein thrombosis: a single-center experience. Transplant Direct. 2018;4:e341.PubMedPubMedCentralCrossRef

36.

Ghabril M, Agarwal S, Lacerda M et al. Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation: analysis of risk factors and outcomes for portal vein thrombosis in waitlisted patients. Transplantation. 2016;100:126–133.PubMedCrossRef

37.

Ozer A, Aktas H, Yilmaz TU et al. Liver transplant in patients with portal vein thrombosis: the experience of 55 patients. Exp Clin Transplant. 2019. https://doi.org/10.6002/ect.2018.0260.CrossRefPubMed

38.

Sharma R, Kashyap R, Jain A et al. Surgical complications following liver transplantation in patients with portal vein thrombosis–a single-center perspective. J Gastrointest Surg. 2010;14:520–527.PubMedCrossRef

39.

Kadry Z, Selzner N, Handschin A et al. Living donor liver transplantation in patients with portal vein thrombosis: a survey and review of technical issues. Transplantation. 2002;74:696–701.PubMedCrossRef

40.

Kwong A, Kim WR, Lake JR et al. OPTN/SRTR 2018 annual data report: liver. Am J Transplant. 2020;20:193–299.PubMedCrossRef

41.

Olthoff KM, Merion RM, Ghobrial RM et al. Outcomes of 385 adult-to-adult living donor liver transplant recipients: a report from the A2ALL Consortium. Ann Surg. 2005;242:314–323 (Discussion 323-315).PubMedPubMedCentralCrossRef

42.

Marcos A. Right lobe living donor liver transplantation: a review. Liver Transpl. 2000;6:3–20.PubMedCrossRef

43.

Bak T, Wachs M, Trotter J et al. Adult-to-adult living donor liver transplantation using right-lobe grafts: results and lessons learned from a single-center experience. Liver Transpl. 2001;7:680–686.PubMedCrossRef

44.

Lo CM, Fan ST, Liu CL et al. Lessons learned from one hundred right lobe living donor liver transplants. Ann Surg. 2004;240:151–158.PubMedPubMedCentralCrossRef

Titel: Early Graft Failure After Living-Donor Liver Transplant
verfasst von: Ahmad Anouti
Moustafa Al Hariri
Lisa B. VanWagner
William M. Lee
Arjmand Mufti
Mark Pedersen
Jigesh Shah
Steven Hanish
Parsia A. Vagefi
Thomas G. Cotter
Madhukar S. Patel
Publikationsdatum: 21.02.2024
Verlag: Springer US
Erschienen in: Digestive Diseases and Sciences / Ausgabe 4/2024
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI: https://doi.org/10.1007/s10620-024-08280-5

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Bei Herzinsuffizienz muss „Eisenmangel“ neu definiert werden!

16.05.2024 Herzinsuffizienz Nachrichten

Bei chronischer Herzinsuffizienz macht es einem internationalen Expertenteam zufolge wenig Sinn, die Diagnose „Eisenmangel“ am Serumferritin festzumachen. Das Team schlägt vor, sich lieber an die Transferrinsättigung zu halten.

Herzinfarkt mit 85 – trotzdem noch intensive Lipidsenkung?

16.05.2024 Hypercholesterinämie Nachrichten

Profitieren nach einem akuten Myokardinfarkt auch Betroffene über 80 Jahre noch von einer intensiven Lipidsenkung zur Sekundärprävention? Um diese Frage zu beantworten, wurden jetzt Registerdaten aus Frankreich ausgewertet.

ADHS-Medikation erhöht das kardiovaskuläre Risiko

16.05.2024 Herzinsuffizienz Nachrichten

Erwachsene, die Medikamente gegen das Aufmerksamkeitsdefizit-Hyperaktivitätssyndrom einnehmen, laufen offenbar erhöhte Gefahr, an Herzschwäche zu erkranken oder einen Schlaganfall zu erleiden. Es scheint eine Dosis-Wirkungs-Beziehung zu bestehen.

Erstmanifestation eines Diabetes-Typ-1 bei Kindern: Ein Notfall!

16.05.2024 DDG-Jahrestagung 2024 Kongressbericht

Manifestiert sich ein Typ-1-Diabetes bei Kindern, ist das ein Notfall – ebenso wie eine diabetische Ketoazidose. Die Grundsäulen der Therapie bestehen aus Rehydratation, Insulin und Kaliumgabe. Insulin ist das Medikament der Wahl zur Behandlung der Ketoazidose.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Background

Aim

Methods

Results

Conclusion

Graphical Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2024

Influence of Helicobacter pylori Infection and Eradication on Small Intestinal Bacterial Overgrowth and Abdominal Symptoms

Cholecystokinin-Induced Duodenogastric Bile Reflux Increases the Severity of Indomethacin-Induced Gastric Antral Ulcers in Re-fed Mice

Antibiotics for Dyspepsia: Hp, SIBO, IMO, or Something Else?

Combine Endoluminal Vacuum-Assisted Closure with Basement Membrane Graft for the Treatment of Gastrointestinal Cutaneous Fistula

Factors Underlying the Difference in Response to Fecal Microbiota Transplantation Between IBS Patients with Severe and Moderate Symptoms