Major complications of adult right lobe living liver donors

BACKGROUND：The right lobe of the liver is generally preferred for living donor liver transplantation in adult patients with end-stage liver disease.It is important to know the preoperative factors relating to the major postoperative complications.We therefore evaluated the possible risk factors for predicting postoperative complications in right lobe liver donors.METHODS：Data from 378 donors who had undergone right lobe hepatectomy at our center were evaluated retrospectively. The factors we evaluated induded donor age, gender, body mass index （BMI）, remnant liver volume, operation time, history of previous abdominal surgery, inclusion of the middle hepatic vein and variations in the portal and bile systems. RESUEI＇S： Of the 378 donors, 219 were male and 159 female. None of the donors died, but 124 （32.8%） donors experienced complications including major complications （Clavien scores III and IV） in 27 （7.1%）. Univariate analysis showed that complica- tions were significantly associated with male gender and higher BMI （P〈0.05）, but not with donor age, remnant liver volume, operation time, graft with middle hepatic vein, variations in the portal and bile systems and previous abdominal surgery （P〉0.05）. Multivariate logistic regression analysis showed that major complications were significantly associated with male gender （P=0.005） and higher BMI （P=0.029）. Moreover, the Chi- square test showed that there were significant relationships between major complications and male gender （P=0.010,Z2=6.614, df=l） and BMI 〉25 kg/m2 （P=-0.031, Z2=8.562, df-1）. Of the 96 male donors with BMI 〉25 kg/m2, 14 （14.6%） with major complications had significantly smaller mean remnant liver volume than those （82, 85.4%） without major complications （32.50%± 4.45% vs 34.63%±3.11%, P=0.029）.CONCLUSION： Male donors with BMI 〉25 kg/m2 and a remnant liver volume 〈32.50% had a significantly increased risk for major complications.

Adult-to-adult living donor liver transplantation for acute liver failure in China

AIM:To investigate the long-term outcome of recipients and donors of adult-to-adult living-donor liver transplantation(AALDLT) for acute liver failure(ALF).METHODS:Between January 2005 and March 2010,170 living donor liver transplantations were performed at West China Hospital of Sichuan University.All living liver donor was voluntary and provided informed consent.Twenty ALF patients underwent AALDLT for rapid deterioration of liver function.ALF was defined based on the criteria of the American Association for the Study of Liver Diseases,including evidence of coagulation abnormality [international normalized ratio(INR) ≥ 1.5] and degree of mental alteration without pre-ex-isting cirrhosis and with an illness of < 26 wk duration.We reviewed the clinical indications,operative procedure and prognosis of AALDTL performed on patients with ALF and corresponding living donors.The potential factors of recipient with ALF and corresponding donor outcome were respectively investigated using multivariate analysis.Survival rates after operation were analyzed using the Kaplan-Meier method.Receiver operator characteristic(ROC) curve analysis was undertaken to identify the threshold of potential risk factors.RESULTS:The causes of ALF were hepatitis B(n = 18),drug-induced(n = 1) and indeterminate(n = 1).The score of the model for end-stage liver disease was 37.1 ± 8.6,and the waiting duration of recipients was 5 ± 4 d.The graft types included right lobe(n = 17) and dual graft(n = 3).The mean graft weight was 623.3 ± 111.3 g,which corresponded to graft-torecipient weight ratio of 0.95% ± 0.14%.The segment Ⅴor Ⅷ hepatic vein was reconstructed in 11 right-lobe grafts.The 1-year and 3-year recipient's survival and graft survival rates were 65%(13 of 20).Postoperative results of total bilirubin,INR and creatinine showed obvious improvements in the survived patients.However,the creatinine level of the deaths was increased postoperatively and became more aggravated compared with the level of the survived recipients.Multivariate analysis showed that waiting duration was independently correlated with increased mortality(P = 0.014).Furthermore,ROC curve revealed the cut-off value of waiting time was 5 d(P = 0.011,area under the curve = 0.791) for determining the mortality.The short-term creatinine level with different recipient's waiting duration was described.The recipients with waiting duration ≥ 5 d showed the worse renal function and higher mortality than those with waiting duration < 5 d(66.7% vs 9.1%,P = 0.017).In addition,all donors had no residual morbidity.Furthermore,univariate analysis did not show that short assessment time induced the high morbidity(P = 0.573).CONCLUSION:Timely AALDLT for patients with ALF greatly improves the recipient survival.However,further systemic review is needed to investigate the optimal treatment strategy for ALF.

Is low postoperative cholesterol level really an independent risk factor of adverse outcomes after living donor liver transplantation?

To the Editor:We read with great interest the article by Yang et al.[1]evaluating the effects of postoperative serum total cholesterol(s TC)changes on early allograft dysfunction and survival after living donor liver transplantation(LDLT).By the multivariate regression analysis,they showed that patients with s TC<1.42 mmol/L on postoperative day 3 had 4.08-fold and 2.72-fold greater risks of

Recurrent hepatitis C after liver transplant

End stage liver disease from hepatitis C is the most common indication for liver transplantation in many parts of the world accounting for up to 40% of liver transplants. Antiviral therapy either before or after liver transplantation is challenging due to side effects and lower efficacy in patients with cirrhosis and liver transplant recipients, as well as from drug interactions with immunosuppressants. Factors that may affect recurrent hepatitis C include donor age, immunosuppression, IL28 B genotype, cytomegalovirus infection, and metabolic syndrome. Older donor age has persistently been shown to have the greatest impact on recurrent hepatitis C. After liver transplantation, distinguishing recurrent hepatitis C from acute cellular rejection may be difficult, although the development of molecular markers may help in making the correct diagnosis. The advent of interferon free regimens with direct acting antiviral agents that include NS3/4A protease inhibitors, NS5 B polymerase inhibitors and NS5 A inhibitors holds great promise in improving outcomes for liver transplant candidates and recipients.