OBJECTIVE: The objective of this study was to characterize the patient population with respect to patient selection, assess surgical morbidity and graft failures, and analyze the contribution of perioperative clinical factors to recipient outcome in adult living donor liver transplantation (ALDLT). SUMMARY BACKGROUND DATA: Previous reports have been center-specific or from large databases lacking detailed variables. The Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) represents the first detailed North American multicenter report of recipient risk and outcome aiming to characterize variables predictive of graft failure. METHODS: Three hundred eighty-five ALDLT recipients transplanted at 9 centers were studied with analysis of over 35 donor, recipient, intraoperative, and postoperative variables. Cox regression models were used to examine the relationship of variables to the risk of graft failure. RESULTS: Ninety-day and 1-year graft survival were 87% and 81%, respectively. Fifty-one (13.2%) grafts failed in the first 90 days. The most common causes of graft failure were vascular thrombosis, primary nonfunction, and sepsis. Biliary complications were common (30% early, 11% late). Older recipient age and length of cold ischemia were significant predictors of graft failure. Center experience greater than 20 ALDLT was associated with a significantly lower risk of graft failure. Recipient Model for End-stage Liver Disease score and graft size were not significant predictors. CONCLUSIONS: This multicenter A2ALL experience provides evidence that ALDLT is a viable option for liver replacement. Older recipient age and prolonged cold ischemia time increase the risk of graft failure. Outcomes improve with increasing center experience.
OBJECTIVE: The objective of this study was to characterize the patient population with respect to patient selection, assess surgical morbidity and graft failures, and analyze the contribution of perioperative clinical factors to recipient outcome in adult living donor liver transplantation (ALDLT). SUMMARY BACKGROUND DATA: Previous reports have been center-specific or from large databases lacking detailed variables. The Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) represents the first detailed North American multicenter report of recipient risk and outcome aiming to characterize variables predictive of graft failure. METHODS: Three hundred eighty-five ALDLT recipients transplanted at 9 centers were studied with analysis of over 35 donor, recipient, intraoperative, and postoperative variables. Cox regression models were used to examine the relationship of variables to the risk of graft failure. RESULTS: Ninety-day and 1-year graft survival were 87% and 81%, respectively. Fifty-one (13.2%) grafts failed in the first 90 days. The most common causes of graft failure were vascular thrombosis, primary nonfunction, and sepsis. Biliary complications were common (30% early, 11% late). Older recipient age and length of cold ischemia were significant predictors of graft failure. Center experience greater than 20 ALDLT was associated with a significantly lower risk of graft failure. Recipient Model for End-stage Liver Disease score and graft size were not significant predictors. CONCLUSIONS: This multicenter A2ALL experience provides evidence that ALDLT is a viable option for liver replacement. Older recipient age and prolonged cold ischemia time increase the risk of graft failure. Outcomes improve with increasing center experience.
Authors: Douglas W Hanto; Thomas M Fishbein; C Wright Pinson; Kim M Olthoff; Mitchell L Shiffman; Jeffrey D Punch; Nathan P Goodrich Journal: Am J Transplant Date: 2005-04 Impact factor: 8.086
Authors: Daniel G Maluf; Richard Todd Stravitz; Adrian H Cotterell; Marc P Posner; Mitsuru Nakatsuka; Richard K Sterling; Velimir A Luketic; Mitchell L Shiffman; John M Ham; Amadeo Marcos; Martha K Behnke; Robert A Fisher Journal: Am J Transplant Date: 2005-01 Impact factor: 8.086
Authors: Manish G Amin; Michael P Wolf; John A TenBrook; Richard B Freeman; Steve J Cheng; Daniel S Pratt; John B Wong Journal: Liver Transpl Date: 2004-12 Impact factor: 5.799
Authors: A Marcos; R A Fisher; J M Ham; M L Shiffman; A J Sanyal; V A Luketic; R K Sterling; M P Posner Journal: Transplantation Date: 1999-09-27 Impact factor: 4.939
Authors: M E Wachs; T E Bak; F M Karrer; G T Everson; R Shrestha; T E Trouillot; M S Mandell; T G Steinberg; I Kam Journal: Transplantation Date: 1998-11-27 Impact factor: 4.939
Authors: Peter L Abt; Rachel Rapaport-Kelz; Niraj M Desai; Adam Frank; Seema Sonnad; Elizabeth Rand; James F Markmann; Abraham Shaked; Kim M Olthoff Journal: Liver Transpl Date: 2004-10 Impact factor: 5.799
Authors: Salvatore Gruttadauria; Fabrizio di Francesco; Duilio Pagano; Sergio Li Petri; Davide Cintorino; Marco Spada; Bruno Gridelli Journal: World J Gastrointest Surg Date: 2010-03-27
Authors: Colleen L Jay; Anton I Skaro; Daniela P Ladner; Edward Wang; Vadim Lyuksemburg; Yaojen Chang; Hongmei Xu; Sandhya Talakokkla; Neehar Parikh; Jane L Holl; Gordon B Hazen; Michael M Abecassis Journal: Liver Transpl Date: 2012-06 Impact factor: 5.799
Authors: Carl L Berg; Brenda W Gillespie; Robert M Merion; Robert S Brown; Michael M Abecassis; James F Trotter; Robert A Fisher; Chris E Freise; R Mark Ghobrial; Abraham Shaked; Jeffrey H Fair; James E Everhart Journal: Gastroenterology Date: 2007-09-14 Impact factor: 22.682
Authors: Robert W Eppsteiner; Nicholas G Csikesz; Jessica P Simons; Jennifer F Tseng; Shimul A Shah Journal: J Gastrointest Surg Date: 2008-08-13 Impact factor: 3.452
Authors: Jean C Emond; Nathan P Goodrich; James J Pomposelli; Talia B Baker; Abhinav Humar; David R Grant; Peter Abt; Chris E Friese; Robert A Fisher; Igal Kam; Averell H Sherker; Brenda W Gillespie; Robert M Merion Journal: Transplantation Date: 2017-10 Impact factor: 4.939
Authors: Patrick G Northup; Michael M Abecassis; Michael J Englesbe; Jean C Emond; Vanessa D Lee; George J Stukenborg; Lan Tong; Carl L Berg Journal: Liver Transpl Date: 2009-02 Impact factor: 5.799
Authors: Jean C Emond; Robert A Fisher; Gregory Everson; Benjamin Samstein; James J Pomposelli; Binsheng Zhao; Sarah Forney; Kim M Olthoff; Talia B Baker; Brenda W Gillespie; Robert M Merion Journal: Liver Transpl Date: 2015-02 Impact factor: 5.799