title: Complications and Their Resolution in Recipients of Deceased and Living Donor Liver Transplants: Findings From the A2ALL Cohort Study.
abstract: The purpose of this study was to explore long-term complications in recipients of deceased donor liver transplant (DDLT) and living donor liver transplant (LDLT) in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL). We analyzed 471 DDLTs and 565 LDLTs from 1998 to 2010 that were followed up to 10 years for 36 categories of complications. Probabilities of complications and their resolutions were estimated using the Kaplan-Meier method, and predictors were tested in Cox proportional hazards models. Median follow-up for DDLT and LDLT was 4.19 and 4.80 years, respectively. DDLT recipients were more likely to have hepatocellular carcinoma and higher disease severity, including Model for End-Stage Liver Disease score. Complications occurring with higher probability in LDLT included biliary-related complications and hepatic artery thrombosis. In DDLT, ascites, intra-abdominal bleeding, cardiac complications and pulmonary edema were significantly more probable. Development of chronic kidney disease stage 4 or 5 was less likely in LDLT recipients (hazard ratio [HR] 0.41, p = 0.02). DDLT and LDLT had similar risk of grade 4 complications (HR 0.89, p = 0.60), adjusted for other risk factors. Once a complication occurred, the time to resolution did not differ between LDLT and DDLT. Future efforts should be directed toward reducing the occurrence of complications after liver transplantation.
authors.affiliation: Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: B
authors.initials: B
authors.lastname: Samstein
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, MI.|Arbor Research Collaborative for Health, Ann Arbor, MI.
authors.forename: A R
authors.initials: AR
authors.lastname: Smith
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, CA.
authors.forename: C E
authors.initials: CE
authors.lastname: Freise
authors.affiliation: Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: M A
authors.initials: MA
authors.lastname: Zimmerman
authors.affiliation: Department of Surgery, Northwestern University, Chicago, IL.
authors.forename: T
authors.initials: T
authors.lastname: Baker
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA.
authors.forename: K M
authors.initials: KM
authors.lastname: Olthoff
authors.affiliation: Division of Transplantation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: R A
authors.initials: RA
authors.lastname: Fisher
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, MI.|Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: R M
authors.initials: RM
authors.lastname: Merion
mesh_terms: D000328:Adult; D002102:Cadaver; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology* / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D066027:Transplant Recipients