title: Clinical analysis of emergency liver transplantation: the role of living donor liver transplantation.
abstract: The current liver allocation system requires reevaluation because of the advancements in peri-transplantation care and surgical techniques. And, the role of living donor liver transplantation (LDLT) in an emergency has not been determined yet. Retrospective review of all patients undergoing emergency liver transplantation (LT) from January 2000 to June 2010 was conducted, and clinical data were analyzed. Of the total 505 LTs, 69 patients (13.7%) underwent an emergency LT. Of these, 54 patients (78.3%) underwent LDLT using a right liver, and 15 patients (21.7%) underwent deceased donor liver transplantation (DDLT). The overall hospital mortality was 21.7% (15/69). The leading cause of death after transplantation was sepsis (60.0%). Multivariate analysis demonstrated that a model for end-stage liver disease (MELD)>33 [hazard ratio (HR), 16.6; 95% confidence interval (CI), 1.443-191.632; p=0.024] and existence of pre-transplantation intubation (HR, 18.2; 95% CI, 1.463-225.483; p=0.024) were independent factors associated with poor survival after emergency LT. LDLT group and DDLT group showed no difference in hospital mortality (p=0.854) and graft survival (p=0.861). Thus, MELD score and respiratory insufficiency could be parameters predicting post-transplant survival. And, LDLT using the right liver could be an appropriate alternative to DDLT in an emergency.
authors.affiliation: Department of Surgery, Daejeon St. Mary's Hospital, the Catholic University of Korea, Daejeon, Korea.
authors.forename: Say-June
authors.initials: SJ
authors.lastname: Kim
authors.forename: Yung-Chul
authors.initials: YC
authors.lastname: Yoon
authors.forename: Young-Kyung
authors.initials: YK
authors.lastname: Yoo
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Park
authors.forename: Dong-Goo
authors.initials: DG
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D018450:Disease Progression; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D017052:Hospital Mortality; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult