title: The morbidity and survival of 196 consecutive cases undergoing liver transplantation in a single center in Mainland China: ten-year experience.
abstract: BACKGROUND
  Right lobar living donor living transplantation (LDLT) has been controversial because of widely differing reports of recipient morbidity. Herein, we present our nearly 10-year experience and identify factors that potentially could be modified to improve recipient outcome.
  
  
  METHODS
  The Clavien 5-tier grading system was applied retrospectively in 196 consecutive adult right lobar recipients. We determined the incidence of potentially life- threatening (Grade III), actually life-threatening (Grade IV), and lethal (Grade V) complications during the first post-transplant year. The most serious and seminal complication was considered if simultaneous or multiple complications appeared.
  
  
  RESULTS
  One-year recipient/graft survival was 82%/82%. Within the first year, 68 (34.69%) of the 196 recipients had Grade III (n=31), Grade IV (n=7), or Grade V (n=30) complications. The complications were 19.90% graft-related and 15.82% non-graft-related. Complications during the first half year did not decline with increased team experience over time and adversely affected recipients' long-term survival, albeit not significantly. According to univariate analysis, high Child-Pugh scores before transplantation (P=0.016), prolonged ICU-stay (P=0.003) and hospitalization time (P=0.032) after transplantation were found to be risk factors for the appearance of ≥ Clavien III complications, while duct-to-duct biliary reconstruction (P=0.02) had a beneficial role in reducing serious complications after LDLTs.
  
  
  CONCLUSIONS
  In conclusion, serious complications during the first post-transplant year shortened recipient survival and prolonged primary hospitalization duration and postoperative ICU-stay, which is more frequent in recipients with higher Child-Pugh scores and in those with hepaticojejunostomy.
authors.affiliation: Department of Liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu, China (mainland).
authors.forename: Peixian
authors.initials: P
authors.lastname: Chen
authors.affiliation: Department of Liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu, China (mainland).
authors.forename: Wentao
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu, China (mainland).
authors.forename: Lunan
authors.initials: L
authors.lastname: Yan
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D008107:Liver Diseases / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult