Strategies for successful left-lobe living donor liver transplantation in 250 consecutive adult cases in a single center

Toru Ikegami, Ken Shirabe, Yuji Soejima, Tomoharu Yoshizumi, Hideaki Uchiyama, Yo Ichi Yamashita, Norifumi Harimoto, Takeo Toshima, Shohei Yoshiya, Tetsuo Ikeda, Yoshihiko Maehara

Research output: Contribution to journalArticle

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Abstract

Background: Living donor liver transplantation (LDLT) using left-lobe grafts was not generally recognized as feasible due to the problem of graft size. Study Design: We retrospectively evaluated strategies for successful left-lobe LDLT in 250 consecutive cases stratified into 2 eras: Era 1 (n = 121), in which surgical procedures were continually refined, and Era 2 (n = 129), in which established procedures were used. Results: Graft volume (GV) did not affect the incidence of graft function or survival. Era 2 patients had decreased portal vein (PV) pressure at closure (16.0 ± 3.5 mmHg vs 19.1 ± 4.6 mmHg, p < 0.01), increased PV flow/GV (301 ± 125 mL/min/100g vs 391 ± 142 mL/min/100g, p < 0.01), and improved graft survival rate (1-year: 90.6% vs 81.8%. p < 0.01) despite the smaller GV/standard volume (SLV) ratio (36.2% ± 5.2% vs 41.2% ± 8.8%, p < 0.01) compared with Era 1. Patients in Era 2 had lower PV pressure and greater PV flow (y = 598-5.7x, p = 0.02) at any GV/SLV compared with cases in Era 1 (y = 480-4.3x, p < 0.01), representing greater graft compliance. Univariate analysis for graft survival showed that Era 1, Model for End-Stage Liver Disease (MELD) score ≥20, inpatient status, closing portal venous pressure ≥20 mmHg, no splenectomy, and operative blood loss ≥10L were the risk factors for graft loss, and multivariate analysis showed that Era 1 was the only significant factor (p < 0.01). During Era 2, development of primary graft dysfunction was associated with inpatient recipient status (p = 0.02) and donor age ≥45 years (p < 0.01). Conclusions: The outcomes of left-lobe LDLT were improved by accumulated experience and technical developments.

Original languageEnglish
Pages (from-to)353-362
Number of pages10
JournalJournal of the American College of Surgeons
Volume216
Issue number3
DOIs
Publication statusPublished - Mar 1 2013

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Living Donors
Liver Transplantation
Transplants
Portal Vein
Portal Pressure
Graft Survival
Inpatients
Primary Graft Dysfunction
End Stage Liver Disease
Splenectomy
Compliance
Multivariate Analysis
Survival Rate
Tissue Donors
Survival
Incidence

All Science Journal Classification (ASJC) codes

  • Surgery

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Strategies for successful left-lobe living donor liver transplantation in 250 consecutive adult cases in a single center. / Ikegami, Toru; Shirabe, Ken; Soejima, Yuji; Yoshizumi, Tomoharu; Uchiyama, Hideaki; Yamashita, Yo Ichi; Harimoto, Norifumi; Toshima, Takeo; Yoshiya, Shohei; Ikeda, Tetsuo; Maehara, Yoshihiko.

In: Journal of the American College of Surgeons, Vol. 216, No. 3, 01.03.2013, p. 353-362.

Research output: Contribution to journalArticle

Ikegami, Toru ; Shirabe, Ken ; Soejima, Yuji ; Yoshizumi, Tomoharu ; Uchiyama, Hideaki ; Yamashita, Yo Ichi ; Harimoto, Norifumi ; Toshima, Takeo ; Yoshiya, Shohei ; Ikeda, Tetsuo ; Maehara, Yoshihiko. / Strategies for successful left-lobe living donor liver transplantation in 250 consecutive adult cases in a single center. In: Journal of the American College of Surgeons. 2013 ; Vol. 216, No. 3. pp. 353-362.
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abstract = "Background: Living donor liver transplantation (LDLT) using left-lobe grafts was not generally recognized as feasible due to the problem of graft size. Study Design: We retrospectively evaluated strategies for successful left-lobe LDLT in 250 consecutive cases stratified into 2 eras: Era 1 (n = 121), in which surgical procedures were continually refined, and Era 2 (n = 129), in which established procedures were used. Results: Graft volume (GV) did not affect the incidence of graft function or survival. Era 2 patients had decreased portal vein (PV) pressure at closure (16.0 ± 3.5 mmHg vs 19.1 ± 4.6 mmHg, p < 0.01), increased PV flow/GV (301 ± 125 mL/min/100g vs 391 ± 142 mL/min/100g, p < 0.01), and improved graft survival rate (1-year: 90.6{\%} vs 81.8{\%}. p < 0.01) despite the smaller GV/standard volume (SLV) ratio (36.2{\%} ± 5.2{\%} vs 41.2{\%} ± 8.8{\%}, p < 0.01) compared with Era 1. Patients in Era 2 had lower PV pressure and greater PV flow (y = 598-5.7x, p = 0.02) at any GV/SLV compared with cases in Era 1 (y = 480-4.3x, p < 0.01), representing greater graft compliance. Univariate analysis for graft survival showed that Era 1, Model for End-Stage Liver Disease (MELD) score ≥20, inpatient status, closing portal venous pressure ≥20 mmHg, no splenectomy, and operative blood loss ≥10L were the risk factors for graft loss, and multivariate analysis showed that Era 1 was the only significant factor (p < 0.01). During Era 2, development of primary graft dysfunction was associated with inpatient recipient status (p = 0.02) and donor age ≥45 years (p < 0.01). Conclusions: The outcomes of left-lobe LDLT were improved by accumulated experience and technical developments.",
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AU - Ikegami, Toru

AU - Shirabe, Ken

AU - Soejima, Yuji

AU - Yoshizumi, Tomoharu

AU - Uchiyama, Hideaki

AU - Yamashita, Yo Ichi

AU - Harimoto, Norifumi

AU - Toshima, Takeo

AU - Yoshiya, Shohei

AU - Ikeda, Tetsuo

AU - Maehara, Yoshihiko

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N2 - Background: Living donor liver transplantation (LDLT) using left-lobe grafts was not generally recognized as feasible due to the problem of graft size. Study Design: We retrospectively evaluated strategies for successful left-lobe LDLT in 250 consecutive cases stratified into 2 eras: Era 1 (n = 121), in which surgical procedures were continually refined, and Era 2 (n = 129), in which established procedures were used. Results: Graft volume (GV) did not affect the incidence of graft function or survival. Era 2 patients had decreased portal vein (PV) pressure at closure (16.0 ± 3.5 mmHg vs 19.1 ± 4.6 mmHg, p < 0.01), increased PV flow/GV (301 ± 125 mL/min/100g vs 391 ± 142 mL/min/100g, p < 0.01), and improved graft survival rate (1-year: 90.6% vs 81.8%. p < 0.01) despite the smaller GV/standard volume (SLV) ratio (36.2% ± 5.2% vs 41.2% ± 8.8%, p < 0.01) compared with Era 1. Patients in Era 2 had lower PV pressure and greater PV flow (y = 598-5.7x, p = 0.02) at any GV/SLV compared with cases in Era 1 (y = 480-4.3x, p < 0.01), representing greater graft compliance. Univariate analysis for graft survival showed that Era 1, Model for End-Stage Liver Disease (MELD) score ≥20, inpatient status, closing portal venous pressure ≥20 mmHg, no splenectomy, and operative blood loss ≥10L were the risk factors for graft loss, and multivariate analysis showed that Era 1 was the only significant factor (p < 0.01). During Era 2, development of primary graft dysfunction was associated with inpatient recipient status (p = 0.02) and donor age ≥45 years (p < 0.01). Conclusions: The outcomes of left-lobe LDLT were improved by accumulated experience and technical developments.

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