title: Low-volume deceased donor liver transplantation alongside a strong living donor liver transplantation service.
abstract: BACKGROUND
  At our center, living donor liver transplantation (LDLT) is the main workload supported by a strong, mature service. Deceased donor liver transplantation (DDLT) is performed but in small volume. This study aimed to review the results of a low-volume DDLT service alongside a strong LDLT service.
  
  
  METHODS
  Consecutive DDLTs for adults performed from 1991 to 2009 were reviewed. The 1st to the 50th DDLTs were categorized as Era I cases, and the rest were Era II cases. The outcomes of the DDLTs were analyzed and compared with those achieved overseas.
  
  
  RESULTS
  Eras I and II consisted of 59 and 183 DDLTs, respectively. All donors were brain-dead and heart-beating with a median age of 49 years (range 7-76 years). Among the 242 DDLTS, 30.2 % were on a high-urgency basis and 15.3 % were for hepatocellular carcinoma. The patients had a median model for end-stage liver disease score of 21 (range 6-40), and most (67.8 %) were hepatitis B virus carriers. Before transplantation, 16.1 % of the patients were in the intensive care unit and 30.2 % were in the hospital. The hospital mortality rate dropped from 13.6 % (8/59) during Era I to 3.8 % (7/183) during Era II (p = 0.012). For Era I, the 1-, 3-, and 5-year survival rates were 84.7, 79.7, and 76.3 %, respectively, which improved to 92.9, 89.0 and 87.2 % for Era II (p = 0.026).
  
  
  CONCLUSIONS
  The recipient survival of this series compares favorably with contemporary series. It is shown that a low-volume DDLT service alongside a strong LDLT service can have excellent results.
authors.affiliation: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
authors.forename: Kevin K W
authors.initials: KK
authors.lastname: Chu
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.forename: William W
authors.initials: WW
authors.lastname: Sharr
authors.forename: Kenneth S H
authors.initials: KS
authors.lastname: Chok
authors.forename: Wing Chiu
authors.initials: WC
authors.lastname: Dai
authors.forename: Chung Mau
authors.initials: CM
authors.lastname: Lo
mesh_terms: D000293:Adolescent; D000328:Adult; D002102:Cadaver; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006723:Hong Kong; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000379:methods* / Q000706:statistics & numerical data*; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D009927:Tissue and Organ Procurement / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult