Kenneth Siu Ho Chok1,2, Albert C Y Chan3,4, James Y Y Fung4,5, Wing Chiu Dai3, Tan To Cheung3,4, Chung Mau Lo3,4. 1. Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. kennethchok@gmail.com. 2. State Key Laboratory for Liver Research, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. kennethchok@gmail.com. 3. Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. 4. State Key Laboratory for Liver Research, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. 5. Department of Medicine, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
Abstract
BACKGROUND AND PURPOSE: There is a big controversy over liver retransplantation, the only life-saving treatment for patients with a failing or failed liver graft. This retrospective study tried to determine if living-donor liver retransplantation (re-LDLT) is a justifiable alternative to deceased-donor liver retransplantation (re-DDLT). METHODS: Anonymous data of liver transplant patients from January 2000 to April 2016 were reviewed. Recipients of retransplantation were divided into the re-DDLT and re-LDLT groups. The groups were compared in demographic characteristics, pre-retransplant and intraoperative details, and short- and long-term outcomes. Risk for living donors was examined. RESULTS: Twenty-nine patients had 33 re-DDLTs and 15 patients received re-LDLT. The re-LDLT group had lighter grafts (525 vs. 1295 g, p ≤ 0.001), a smaller ratio of graft weight to recipient standard liver volume (56.98 vs. 107.7%, p ≤ 0.001), and shorter cold ischemia (106 vs. 451 min, p ≤ 0.001). The groups were otherwise comparable. Two patients in the re-DDLT group had Grade-5 complication. The groups were similar in patient survival (p = 0.326) and graft survival (p = 0.102). No living donors died, but three of them developed Grade-1 complications. CONCLUSION: With the required expertise, re-LDLT can produce results comparable to those of re-DDLT while keeping donor risk at bay. In places where the demand for deceased-donor liver grafts far outstrips supply, re-LDLT can be considered as an alternative to re-DDLT if the expertise is available and if the potential recipient benefits can balance out the potential donor risks.
BACKGROUND AND PURPOSE: There is a big controversy over liver retransplantation, the only life-saving treatment for patients with a failing or failed liver graft. This retrospective study tried to determine if living-donor liver retransplantation (re-LDLT) is a justifiable alternative to deceased-donor liver retransplantation (re-DDLT). METHODS: Anonymous data of liver transplant patients from January 2000 to April 2016 were reviewed. Recipients of retransplantation were divided into the re-DDLT and re-LDLT groups. The groups were compared in demographic characteristics, pre-retransplant and intraoperative details, and short- and long-term outcomes. Risk for living donors was examined. RESULTS: Twenty-nine patients had 33 re-DDLTs and 15 patients received re-LDLT. The re-LDLT group had lighter grafts (525 vs. 1295 g, p ≤ 0.001), a smaller ratio of graft weight to recipient standard liver volume (56.98 vs. 107.7%, p ≤ 0.001), and shorter cold ischemia (106 vs. 451 min, p ≤ 0.001). The groups were otherwise comparable. Two patients in the re-DDLT group had Grade-5 complication. The groups were similar in patient survival (p = 0.326) and graft survival (p = 0.102). No living donors died, but three of them developed Grade-1 complications. CONCLUSION: With the required expertise, re-LDLT can produce results comparable to those of re-DDLT while keeping donor risk at bay. In places where the demand for deceased-donor liver grafts far outstrips supply, re-LDLT can be considered as an alternative to re-DDLT if the expertise is available and if the potential recipient benefits can balance out the potential donor risks.
Authors: Kenneth S H Chok; James Y Y Fung; Albert C Y Chan; Wing Chiu Dai; William W Sharr; Tan To Cheung; See Ching Chan; Chung Mau Lo Journal: Ann Surg Date: 2017-01 Impact factor: 12.969
Authors: Kenneth Siu Ho Chok; See Ching Chan; Tan To Cheung; William Wei Sharr; Albert Chi Yan Chan; Chung Mau Lo; Sheung Tat Fan Journal: Liver Transpl Date: 2011-01 Impact factor: 5.799
Authors: Wing Chiu Dai; See Ching Chan; Kenneth S H Chok; Tan To Cheung; William W Sharr; Albert C Y Chan; James Y Y Fung; Tiffany C L Wong; Chung Mau Lo Journal: J Hepatobiliary Pancreat Sci Date: 2014-02-18 Impact factor: 7.027
Authors: Henrik Petrowsky; Abbas Rana; Fady M Kaldas; Anuj Sharma; Johnny C Hong; Vatche G Agopian; Francisco Durazo; Henry Honda; Jeffrey Gornbein; Victor Wu; Douglas G Farmer; Jonathan R Hiatt; Ronald W Busuttil Journal: Ann Surg Date: 2014-06 Impact factor: 12.969
Authors: Hillary J Braun; Joshua D Grab; Jennifer L Dodge; Shareef M Syed; Garrett R Roll; Marisa P Schwab; Iris H Liu; Alexa C Glencer; Chris E Freise; John P Roberts; Nancy L Ascher Journal: Transplantation Date: 2021-06-01 Impact factor: 5.385