title: Recipient morbidity after living and deceased donor liver transplantation: findings from the A2ALL Retrospective Cohort Study.
abstract: Patients considering living donor liver transplantation (LDLT) need to know the risk and severity of complications compared to deceased donor liver transplantation (DDLT). One aim of the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) was to examine recipient complications following these procedures. Medical records of DDLT or LDLT recipients who had a living donor evaluated at the nine A2ALL centers between 1998 and 2003 were reviewed. Among 384 LDLT and 216 DDLT, at least one complication occurred after 82.8% of LDLT and 78.2% of DDLT (p = 0.17). There was a median of two complications after DDLT and three after LDLT. Complications that occurred at a higher rate (p < 0.05) after LDLT included biliary leak (31.8% vs. 10.2%), unplanned reexploration (26.2% vs. 17.1%), hepatic artery thrombosis (6.5% vs. 2.3%) and portal vein thrombosis (2.9% vs. 0.0%). There were more complications leading to retransplantation or death (Clavien grade 4) after LDLT versus DDLT (15.9% vs. 9.3%, p = 0.023). Many complications occurred more commonly during early center experience; the odds of grade 4 complications were more than two-fold higher when centers had performed <or=20 LDLT (vs. >40). In summary, complication rates were higher after LDLT versus DDLT, but declined with center experience to levels comparable to DDLT.
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, CA, USA. freisec@surgery.ucsf.edu
authors.forename: C E
authors.initials: CE
authors.lastname: Freise
authors.forename: B W
authors.initials: BW
authors.lastname: Gillespie
authors.forename: A J
authors.initials: AJ
authors.lastname: Koffron
authors.forename: A S F
authors.initials: AS
authors.lastname: Lok
authors.forename: T L
authors.initials: TL
authors.lastname: Pruett
authors.forename: J C
authors.initials: JC
authors.lastname: Emond
authors.forename: J H
authors.initials: JH
authors.lastname: Fair
authors.forename: R A
authors.initials: RA
authors.lastname: Fisher
authors.forename: K M
authors.initials: KM
authors.lastname: Olthoff
authors.forename: J F
authors.initials: JF
authors.lastname: Trotter
authors.forename: R M
authors.initials: RM
authors.lastname: Ghobrial
authors.forename: J E
authors.initials: JE
authors.lastname: Everhart
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology; D014019:Tissue Donors / Q000706:statistics & numerical data*; D014180:Transplantation / Q000706:statistics & numerical data*; D016896:Treatment Outcome