Introduction
Patients and methods
Results
Preoperative data
Fulminant hepatic failure (n = 37) | Acute exacerbation of chronic hepatitis B (n = 50) | Cirrhosis with acute deterioration (n = 99) | Cirrhosis (n = 301) | |
---|---|---|---|---|
Male: Female | 13:24 | 39:11 | 85:14 | 224:77 |
Age, median (range) | 34 (19–60) | 44 (17–63) | 49 (17–66) | 50 (17–68) |
Pre-transplant status | ||||
Intensive care unit-bound | 31 (83.8%) | 32 (64%) | 59 (59.6%) | 12 (4%) |
Hospital-bound | 6 (16.2%) | 17 (34%) | 40 (40.4%) | 67 (22.2%) |
From home | 0 | 1 (2%) | 0 | 222 (73.8%) |
MELD score, median (range) | 37 (27–52) | 37 (28–52) | 35 (19–59) | 17 (6–41) |
Serum bilirubin (μmol/l), median (range) | 549 (91–879) | 570 (321–957) | 585 (86–1,209) | 57 (9–957) |
Serum ALT (IU/l), median (range) | 502 (33–7,150) | 331 (34–2,389) | 75 (14–4,020) | 43 (7–270) |
Serum AST (IU/l), median (range) | 281 (77–10,000) | 178 (46–2,056) | 117 (33–5,590) | 64 (21–300) |
Serum urea (mmol/l), median (range) | 2.4 (0.2–36) | 4.25 (0.4–32) | 6.8 (1.7–51.9) | 4.9 (1.6–36.6) |
Serum creatinine (μmol/l), median (range) | 82 (36–658) | 103 (43–563) | 115 (38–971) | 86 (39–896) |
White cell count (×109/l), median (range) | 9.35 (3.3–49.4) | 9.35 (1.8–25.5) | 7.85 (1.7–30.2) | 4.2 (0.7–17.9) |
Platelet count (× 109/l), median (range) | 129 (44–671) | 127 (45–352) | 62 (17–360) | 57 (11–537) |
INR, median (range) | 4.4 (1.8–8.4) | 3.5 (1.8–5.7) | 2.8 (1.6–10.0) | 1.5 (1.0–4.4) |
Hepatic encephalopathy | ||||
Grade 0 | 2a
| 12 | 33 | 292 |
Grade 1 | 4 | 5 | 11 | 4 |
Grade 2 | 6 | 6 | 19 | 1 |
Grade 3 | 11 (29.7%) | 15 (30%) | 14 (14.1%) | 2 |
Grade 4 | 14 (37.8%) | 12 (24%) | 22 (22%) | 2 |
Preoperative infection | 7 (18.9%) | 16 (32%) | 36 (36.4%) | 6 (2.0%) |
Respiratory tract | 2 | 6 | 21 | 2 |
Urinary tract | 4 | 4 | 11 | 1 |
Ascites | 0 | 1 | 0 | 3 |
Blood | 1 | 7 | 15 | 1 |
Other sites | 0 | 0 | 8 | 3 |
Hepatorenal syndrome | 10 (27%) | 16 (32%) | 41 (41.4%) | 2 (0.7%) |
Preoperative hemodialysis | 6 (16.2%) | 8 (16%) | 20 (20.2%) | 0 (0%) |
Mechanical ventilation support | 20 (54.1%) | 17 (34%) | 26 (26.3%) | 2 (0.7%) |
Acute exacerbation of hepatitis B (n = 50) | Cirrhosis with acute deterioration (n = 99) | |
---|---|---|
Unknown | 30 | 71 |
Herbal medicine | 15 | 11 |
Steroid | 3 | 2 |
Interleukin | 1 | 0 |
Cyclosporine A withdrawal | 1 | 0 |
Hepatitis E infection | 0 | 1 |
YMDD mutant | 0 | 3 |
Withdrawal of nucleoside analogue | 0 | 1 |
Wilson disease | 0 | 3 |
Unknown hepatitis C virus | 0 | 1 |
Post-hepatectomy portal vein thrombosis | 0 | 1 |
Anti-tuberculosis drugs | 0 | 1 |
Unknown Wilson disease | 0 | 4 |
Bacteria | Fungus | ||||||
---|---|---|---|---|---|---|---|
MRSA | MSSA |
E. coli
| Klebsiella | Pseudomonas | Others | Candida | |
Patient group
| |||||||
Fulminant hepatic failure | 1 | 0 | 2 | 2 | 0 | 2 | 2 |
Acute exacerbation of chronic hepatitis B | 0 | 1 | 2 | 3 | 1 | 11 | 3 |
Cirrhosis with acute deterioration | 9 | 10 | 8 | 5 | 3 | 19 | 14 |
Cirrhosis | 1 | 0 | 2 | 0 | 0 | 2 | 2 |
Site of origin
| |||||||
Respiratory tract | 4 | 6 | 1 | 5 | 3 | 18 | 14 |
Urinary tract | 2 | 0 | 8 | 4 | 0 | 9 | 7 |
Ascites | 2 | 0 | 1 | 0 | 1 | 0 | 1 |
Blood | 3 | 3 | 8 | 2 | 1 | 7 | 1 |
Other sites | 1 | 2 | 2 | 0 | 1 | 1 | 5 |
Intraoperative data
Fulminant hepatic failure (n = 37) | Acute exacerbation of chronic hepatitis B (n = 50) | Cirrhosis with acute deterioration (n = 99) | Cirrhosis (n = 301) | |
---|---|---|---|---|
LDLT: DDLT | 31:6 | 38:12 | 65:34 | 170:131 |
Graft weight/ESLV (%) | 53.6 (27.4–117.1) | 52.7 (36.9–135.5) | 54.0 (28.4–140.8) | 59.3 (27.3–186.8) |
Graft weight/recipient body weight (%) | 1.05 (0.53–1.98) | 0.99 (0.64–2.65) | 1.01 (0.49–3.07) | 1.14 (0.49–4.29) |
Living donor graft weight/ESLV (%) | 52.2 (27.4–89.4) | 49.7 (36.9–86.9) | 46.8 (28.4–68.9) | 49.0 (27.3–79.5) |
Living donor graft weight/recipient body weight (%) | 0.95 (0.53–1.92) | 0.90 (0.64–1.95) | 0.87 (0.49–1.31) | 0.91 (0.49–1.51) |
Blood transfusion units, median (range) | 7 (0–15) | 4.5 (0–30) | 7 (0–58) | 5 (0–108) |
No. of patients without blood transfusion | 7 (18.9%) | 5 (10%) | 3 (3%) | 66 (21.9%) |
FFP transfusion units, median (range) | 12 (2–26) | 13 (3–37) | 13 (5–48) | 8 (0–66) |
Platelet transfusion units, median (range) | 6 (0–20) | 5 (0–32) | 12 (0–53) | 10 (0–51) |
Intraoperative hemodialysis | 1 (2.7%) | 1 (2.0%) | 5 (5.1%) | 0 (0%) |
Concomitant hepatocellular carcinoma | 0 (0%) | 0 (0%) | 11 (11.1%) | 105 (34.9%) |
Incidental hepatocellular carcinoma | 0 | 0 | 5 (45.5%) | 6 (5.7%) |
TNM stage I | 0 | 0 | 5 (45.5%) | 41 (39%) |
TNM stage II | 0 | 0 | 5 (45.5%) | 51 (48.6%) |
TNM stage III | 0 | 0 | 1 (9.1%) | 12 (11.4%) |
TNM stage IV | 0 | 0 | 0 (0%) | 1 (1.0%) |
Pathological data
Cirrhosis with acute deterioration (n = 99) | Cirrhosis (n = 301) | |
---|---|---|
Hepatitis B | 85 (85.9%) | 222 (73.8%) |
Hepatitis C | 2 (2%) | 27 (9%) |
Hepatitis B and C | 1 (1%) | 2 (0.7%) |
Wilson disease | 7 (7.1%) | 4 (1.3%) |
Autoimmune hepatitis | 1 (1%) | 3 (1%) |
Alcoholic cirrhosis | 2 (2%) | 14 (4.7%) |
Idiopathic cirrhosis | 1 ((1%) | 6 (2%) |
Secondary biliary cirrhosis | 0 (0%) | 6 (1.7%) |
Primary biliary cirrhosis | 0 (0%) | 16 (5.3%) |
Overlapping syndrome | 0 (0%) | 1 (0.3%) |
Postoperative data
Fulminant hepatic failure (n = 37) | Acute exacerbation of chronic hepatitis B (n = 50) | Cirrhosis with acute deterioration (n = 99) | Cirrhosis (n = 301) | |
---|---|---|---|---|
Early complications (<30 days) | 26 (70.3%) | 31 (62%) | 70 (70.7%) | 158 (52.5%) |
Re-operation | 10 (27%) | 8 (16%) | 22 (22%) | 51 (16.9%) |
LDLT | 8 (25.8%) | 8 (21%) | 15 (23%) | 24 (14.1%) |
DDLT | 2 (33.3%) | 0 (0%) | 7 (20.5%) | 27 (20.6%) |
Postoperative hemodialysis | 2 (5.4%) | 5 (10%) | 11 (11.1%) | 0 (0%) |
Intensive care unit days, median (range) | 6 (1–35) | 6 (1–37) | 5 (1–125) | 4 (1–99) |
Hospital days, median (range) | 29 (8–183) | 18 (10–79) | 24 (8–210) | 17 (0–1,163) |
Hospital mortality | 1 (2.7%) | 2 (4.0%) | 5 (5.1%) | 21 (7%) |
One-year graft survival rate | 97.3% | 94% | 95% | 89.4% |
Three-year graft survival rate | 91.8% | 94% | 90.5% | 81.7% |
Five-year graft survival rate | 87.4% | 91.2% | 90.5% | 76.2% |
Re-transplantation | 3 (8.1%) | 1 (2%) | 0 (0%) | 11 (3.7%) |
One-year overall survival rate | 97.3% | 96% | 95% | 90.7% |
Three-year overall survival rate | 91.8% | 96% | 90.5% | 83.7% |
Five-year overall survival rate | 91.8% | 93.2% | 90.5% | 79.3% |
Survival data
Fulminant hepatic failure (n = 37) | Acute exacerbation of chronic hepatitis B (n = 50) | Cirrhosis with acute deterioration (n = 99) | Cirrhosis (n = 301) | |
---|---|---|---|---|
Septic complications | 0 | 1 | 2 | 4 |
Cardiac complications | 0 | 0 | 0 | 4 |
Respiratory complications | 0 | 0 | 0 | 1 |
Biliary leakage | 0 | 0 | 0 | 1 |
Autoimmune disorders | 1 | 0 | 0 | 1 |
Intracranial pathology | 0 | 0 | 1 | 5 |
Multiorgan failure | 0 | 0 | 1 | 1 |
Graft complications | 0 | 0 | 0 | 3 |
Severe hemorrhage | 0 | 0 | 0 | 1 |
Intraabdominal complications | 0 | 1 | 1 | 0 |
Fulminant hepatic failure (n = 37) | Acute exacerbation of chronic hepatitis B (n = 50) | Cirrhosis with acute deterioration (n = 99) | Cirrhosis (n = 301) | |
---|---|---|---|---|
Rejection | 1 | 0 | 0 | 2 |
Graft complications | 2 | 0 | 2 | 2 |
Hepatitis B/C infection | 0 | 0 | 0 | 3 |
Sepsis | 1 | 0 | 2 | 4 |
Cardiac complications | 0 | 0 | 0 | 1 |
Respiratory complications | 0 | 0 | 0 | 5 |
Hematological disorders | 0 | 0 | 0 | 3 |
Gastrointestinal bleeding | 0 | 0 | 0 | 3 |
Terminal malignancy | 0 | 1 | 1 | 15 |
Others | 1 | 0 | 0 | 2 |