One hundred nine living donor liver transplants in adults and children

A single-center experience

Charles M. Miller, Gabriel E. Gondolesi, Sander Florman, Cal Matsumoto, Luis Muñoz, Tomoharu Yoshizumi, Tarik Artis, Thomas M. Fishbein, Patricia A. Sheiner, Leona Kim-Schluger, Thomas Schiano, Benjamin L. Shneider, Sukru Emre, Myron E. Schwartz

Research output: Contribution to journalArticle

276 Citations (Scopus)

Abstract

Objective: To summarize the evolution of a living donor liver transplant program and the authors' experience with 109 cases. Summary Background Data: The authors' institution began to offer living donor liver transplants to children in 1993 and to adults in 1998. Methods: Donors were healthy, ages 18 to 60 years, related or unrelated, and ABO-compatible (except in one case). Donor evaluation was thorough. Liver biopsy was performed for abnormal lipid profiles or a history of significant alcohol use, a body mass index more than 28, or suspected steatosis. Imaging studies included angiography, computed tomography, endoscopic retrograde cholangiopancreatography, and magnetic resonance imaging. Recipient evaluation and management were the same as for cadaveric transplant. Results: After ABO screening, 136 potential donors were evaluated for 113 recipients; 23 donors withdrew for medical or personal reasons. Four donor surgeries were aborted; 109 transplants were performed. Fifty children (18 years or younger) received 47 left lateral segments and 3 left lobes; 59 adults received 50 right lobes and 9 left lobes. The average donor hospital stay was 6 days. Two donors each required one unit of banked blood. Right lobe donors had three bile leaks from the cut surface of the liver; all resolved. Another right lobe donor had prolonged hyperbilirubinemia. Three donors had small bowel obstructions; two required operation. All donors are alive and well. The most common indications for transplant were biliary atresia in children (56%) and hepatitis C in adults (40%); 35.6% of adults had hepatocellular carcinoma. Biliary reconstructions in all children and 44 adults were with a Roux-en-Y hepaticojejunostomy; 15 adults had duct-to-duct anastomoses. The incidence of major vascular complications was 12% in children and 11.8% in adult recipients. Children had three bile leaks (6%) and six (12%) biliary strictures. Adult patients had 14 (23.7%) bile leaks and 4 (6.8%) biliary strictures. Patient and graft survival rates were 87.6% and 81%, respectively, at 1 year and 75.1% and 69.6% at 5 years. In children, patient and graft survival rates were 89.9% and 85.8%, respectively, at 1 year and 80.9% and 78% at 5 years. In adults, patient and graft survival rates were 85.6% and 77%, respectively, at 1 year. Conclusion: Living donor liver transplantation has become an important option for our patients and has dramatically changed our approach to patients with liver failure. The donor surgery is safe and can be done with minimal complications. We expect that living donor liver transplants will represent more than 50% of our transplants within 3 years.

Original languageEnglish
Pages (from-to)301-312
Number of pages12
JournalAnnals of Surgery
Volume234
Issue number3
DOIs
Publication statusPublished - Sep 26 2001
Externally publishedYes

Fingerprint

Living Donors
Tissue Donors
Transplants
Liver
Graft Survival
Bile
Survival Rate
Pathologic Constriction
Biliary Atresia
Hyperbilirubinemia
Endoscopic Retrograde Cholangiopancreatography
Liver Failure
Hepatitis C
Liver Transplantation
Blood Vessels
Hepatocellular Carcinoma
Length of Stay
Body Mass Index
Alcohols
Magnetic Resonance Imaging

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Miller, C. M., Gondolesi, G. E., Florman, S., Matsumoto, C., Muñoz, L., Yoshizumi, T., ... Schwartz, M. E. (2001). One hundred nine living donor liver transplants in adults and children: A single-center experience. Annals of Surgery, 234(3), 301-312. https://doi.org/10.1097/00000658-200109000-00004

One hundred nine living donor liver transplants in adults and children : A single-center experience. / Miller, Charles M.; Gondolesi, Gabriel E.; Florman, Sander; Matsumoto, Cal; Muñoz, Luis; Yoshizumi, Tomoharu; Artis, Tarik; Fishbein, Thomas M.; Sheiner, Patricia A.; Kim-Schluger, Leona; Schiano, Thomas; Shneider, Benjamin L.; Emre, Sukru; Schwartz, Myron E.

In: Annals of Surgery, Vol. 234, No. 3, 26.09.2001, p. 301-312.

Research output: Contribution to journalArticle

Miller, CM, Gondolesi, GE, Florman, S, Matsumoto, C, Muñoz, L, Yoshizumi, T, Artis, T, Fishbein, TM, Sheiner, PA, Kim-Schluger, L, Schiano, T, Shneider, BL, Emre, S & Schwartz, ME 2001, 'One hundred nine living donor liver transplants in adults and children: A single-center experience', Annals of Surgery, vol. 234, no. 3, pp. 301-312. https://doi.org/10.1097/00000658-200109000-00004
Miller, Charles M. ; Gondolesi, Gabriel E. ; Florman, Sander ; Matsumoto, Cal ; Muñoz, Luis ; Yoshizumi, Tomoharu ; Artis, Tarik ; Fishbein, Thomas M. ; Sheiner, Patricia A. ; Kim-Schluger, Leona ; Schiano, Thomas ; Shneider, Benjamin L. ; Emre, Sukru ; Schwartz, Myron E. / One hundred nine living donor liver transplants in adults and children : A single-center experience. In: Annals of Surgery. 2001 ; Vol. 234, No. 3. pp. 301-312.
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abstract = "Objective: To summarize the evolution of a living donor liver transplant program and the authors' experience with 109 cases. Summary Background Data: The authors' institution began to offer living donor liver transplants to children in 1993 and to adults in 1998. Methods: Donors were healthy, ages 18 to 60 years, related or unrelated, and ABO-compatible (except in one case). Donor evaluation was thorough. Liver biopsy was performed for abnormal lipid profiles or a history of significant alcohol use, a body mass index more than 28, or suspected steatosis. Imaging studies included angiography, computed tomography, endoscopic retrograde cholangiopancreatography, and magnetic resonance imaging. Recipient evaluation and management were the same as for cadaveric transplant. Results: After ABO screening, 136 potential donors were evaluated for 113 recipients; 23 donors withdrew for medical or personal reasons. Four donor surgeries were aborted; 109 transplants were performed. Fifty children (18 years or younger) received 47 left lateral segments and 3 left lobes; 59 adults received 50 right lobes and 9 left lobes. The average donor hospital stay was 6 days. Two donors each required one unit of banked blood. Right lobe donors had three bile leaks from the cut surface of the liver; all resolved. Another right lobe donor had prolonged hyperbilirubinemia. Three donors had small bowel obstructions; two required operation. All donors are alive and well. The most common indications for transplant were biliary atresia in children (56{\%}) and hepatitis C in adults (40{\%}); 35.6{\%} of adults had hepatocellular carcinoma. Biliary reconstructions in all children and 44 adults were with a Roux-en-Y hepaticojejunostomy; 15 adults had duct-to-duct anastomoses. The incidence of major vascular complications was 12{\%} in children and 11.8{\%} in adult recipients. Children had three bile leaks (6{\%}) and six (12{\%}) biliary strictures. Adult patients had 14 (23.7{\%}) bile leaks and 4 (6.8{\%}) biliary strictures. Patient and graft survival rates were 87.6{\%} and 81{\%}, respectively, at 1 year and 75.1{\%} and 69.6{\%} at 5 years. In children, patient and graft survival rates were 89.9{\%} and 85.8{\%}, respectively, at 1 year and 80.9{\%} and 78{\%} at 5 years. In adults, patient and graft survival rates were 85.6{\%} and 77{\%}, respectively, at 1 year. Conclusion: Living donor liver transplantation has become an important option for our patients and has dramatically changed our approach to patients with liver failure. The donor surgery is safe and can be done with minimal complications. We expect that living donor liver transplants will represent more than 50{\%} of our transplants within 3 years.",
author = "Miller, {Charles M.} and Gondolesi, {Gabriel E.} and Sander Florman and Cal Matsumoto and Luis Mu{\~n}oz and Tomoharu Yoshizumi and Tarik Artis and Fishbein, {Thomas M.} and Sheiner, {Patricia A.} and Leona Kim-Schluger and Thomas Schiano and Shneider, {Benjamin L.} and Sukru Emre and Schwartz, {Myron E.}",
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T1 - One hundred nine living donor liver transplants in adults and children

T2 - A single-center experience

AU - Miller, Charles M.

AU - Gondolesi, Gabriel E.

AU - Florman, Sander

AU - Matsumoto, Cal

AU - Muñoz, Luis

AU - Yoshizumi, Tomoharu

AU - Artis, Tarik

AU - Fishbein, Thomas M.

AU - Sheiner, Patricia A.

AU - Kim-Schluger, Leona

AU - Schiano, Thomas

AU - Shneider, Benjamin L.

AU - Emre, Sukru

AU - Schwartz, Myron E.

PY - 2001/9/26

Y1 - 2001/9/26

N2 - Objective: To summarize the evolution of a living donor liver transplant program and the authors' experience with 109 cases. Summary Background Data: The authors' institution began to offer living donor liver transplants to children in 1993 and to adults in 1998. Methods: Donors were healthy, ages 18 to 60 years, related or unrelated, and ABO-compatible (except in one case). Donor evaluation was thorough. Liver biopsy was performed for abnormal lipid profiles or a history of significant alcohol use, a body mass index more than 28, or suspected steatosis. Imaging studies included angiography, computed tomography, endoscopic retrograde cholangiopancreatography, and magnetic resonance imaging. Recipient evaluation and management were the same as for cadaveric transplant. Results: After ABO screening, 136 potential donors were evaluated for 113 recipients; 23 donors withdrew for medical or personal reasons. Four donor surgeries were aborted; 109 transplants were performed. Fifty children (18 years or younger) received 47 left lateral segments and 3 left lobes; 59 adults received 50 right lobes and 9 left lobes. The average donor hospital stay was 6 days. Two donors each required one unit of banked blood. Right lobe donors had three bile leaks from the cut surface of the liver; all resolved. Another right lobe donor had prolonged hyperbilirubinemia. Three donors had small bowel obstructions; two required operation. All donors are alive and well. The most common indications for transplant were biliary atresia in children (56%) and hepatitis C in adults (40%); 35.6% of adults had hepatocellular carcinoma. Biliary reconstructions in all children and 44 adults were with a Roux-en-Y hepaticojejunostomy; 15 adults had duct-to-duct anastomoses. The incidence of major vascular complications was 12% in children and 11.8% in adult recipients. Children had three bile leaks (6%) and six (12%) biliary strictures. Adult patients had 14 (23.7%) bile leaks and 4 (6.8%) biliary strictures. Patient and graft survival rates were 87.6% and 81%, respectively, at 1 year and 75.1% and 69.6% at 5 years. In children, patient and graft survival rates were 89.9% and 85.8%, respectively, at 1 year and 80.9% and 78% at 5 years. In adults, patient and graft survival rates were 85.6% and 77%, respectively, at 1 year. Conclusion: Living donor liver transplantation has become an important option for our patients and has dramatically changed our approach to patients with liver failure. The donor surgery is safe and can be done with minimal complications. We expect that living donor liver transplants will represent more than 50% of our transplants within 3 years.

AB - Objective: To summarize the evolution of a living donor liver transplant program and the authors' experience with 109 cases. Summary Background Data: The authors' institution began to offer living donor liver transplants to children in 1993 and to adults in 1998. Methods: Donors were healthy, ages 18 to 60 years, related or unrelated, and ABO-compatible (except in one case). Donor evaluation was thorough. Liver biopsy was performed for abnormal lipid profiles or a history of significant alcohol use, a body mass index more than 28, or suspected steatosis. Imaging studies included angiography, computed tomography, endoscopic retrograde cholangiopancreatography, and magnetic resonance imaging. Recipient evaluation and management were the same as for cadaveric transplant. Results: After ABO screening, 136 potential donors were evaluated for 113 recipients; 23 donors withdrew for medical or personal reasons. Four donor surgeries were aborted; 109 transplants were performed. Fifty children (18 years or younger) received 47 left lateral segments and 3 left lobes; 59 adults received 50 right lobes and 9 left lobes. The average donor hospital stay was 6 days. Two donors each required one unit of banked blood. Right lobe donors had three bile leaks from the cut surface of the liver; all resolved. Another right lobe donor had prolonged hyperbilirubinemia. Three donors had small bowel obstructions; two required operation. All donors are alive and well. The most common indications for transplant were biliary atresia in children (56%) and hepatitis C in adults (40%); 35.6% of adults had hepatocellular carcinoma. Biliary reconstructions in all children and 44 adults were with a Roux-en-Y hepaticojejunostomy; 15 adults had duct-to-duct anastomoses. The incidence of major vascular complications was 12% in children and 11.8% in adult recipients. Children had three bile leaks (6%) and six (12%) biliary strictures. Adult patients had 14 (23.7%) bile leaks and 4 (6.8%) biliary strictures. Patient and graft survival rates were 87.6% and 81%, respectively, at 1 year and 75.1% and 69.6% at 5 years. In children, patient and graft survival rates were 89.9% and 85.8%, respectively, at 1 year and 80.9% and 78% at 5 years. In adults, patient and graft survival rates were 85.6% and 77%, respectively, at 1 year. Conclusion: Living donor liver transplantation has become an important option for our patients and has dramatically changed our approach to patients with liver failure. The donor surgery is safe and can be done with minimal complications. We expect that living donor liver transplants will represent more than 50% of our transplants within 3 years.

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