A decade of right liver adult-to-adult living donor liver transplantation: the recipient mid-term outcomes.
OBJECTIVE
We analyzed a single center's experience over a decade of right liver living donor liver transplantation (RLDLT).


BACKGROUND
To define the donor risk and recipient benefit ratio, midterm outcome of this life-saving treatment modality ought to be known.


METHODS
Consecutive patients from 9 May 1996 were included. Era I comprised the first 50 patients and Era II comprised the remaining 184 patients. Their midterm outcomes were compared with patients receiving deceased donor liver transplantation (DDLT) of the same period in the same center.


RESULTS
With a median follow-up of 48 months, the 1-, 3-, and 5-year overall survival rates were 93.2%, 85.7%, and 82.4%, respectively and were comparable with those of DDLT (n = 131) (90.1%, 87.7%, and 85.2%) (P = 0.876). Hospital mortality decreased from 16% in Era I to 2.2% in Era II (P = 0.000). Reduced hospital mortality improved the overall survival rates from Era I to Era II (78%, 74%, and 72% vs. 97.3%, 88.7%, and 85.1%, respectively) (P = 0.003). The 5-year survival rate of recipients with hepatocellular carcinoma (HCC) (n = 65) was 65.7%. Starting from Era II, excellent 5-year survival of recipients without HCC was achieved as compared with DDLT in the same period (93.4% vs. 88.2%) (P = 0.493). The 5-year survival rates of recipients with HCC within the Milan criteria of Era II and DDLT in the same period were 72.0% and 100%, respectively (P = 0.091). Multivariate analysis indicated that only Era I (relative risk = 2.606; P = 0.005) and pretransplant HCC (relative risk = 2.729; P = 0.002) adversely affected overall survival.


CONCLUSIONS
High midterm survivals were achieved by reduction of hospital mortality through accumulation of experience and transplanting recipients with low chance of recurrence of HCC. RLDLT could be considered as a legitimate alternative to DDLT.
Chan
See Ching
SC
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China.
Fan
Sheung Tat
ST
Lo
Chung Mau
CM
Liu
Chi Leung
CL
Wei
William I
WI
Chik
Barbara Hsia-Ying
BH
Wong
John
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome