Adult-to-Adult Living Donor Liver Transplant: Hemodynamic Evaluation, Prognosis, and Recipient Selection
| Autor: | Luiz Augusto Carneiro-D’Albuquerque, Lucas Souto Nacif, Wellington Andraus, Rodrigo Martino, Leonardo Yuri Zanini, Daniel Reis Waisberg, Liliana Ducatti, Vinicius Rocha-Santos, Rafael S. Pinheiro, Luciana Bertocco de Paiva Haddad, João Paulo Costa dos Santos, Juliana Marquezi Pereira, Flávio Henrique Ferreira Galvão, Rubens Macedo Arantes |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Hemodynamics Single Center Risk Assessment Severity of Illness Index Donor Selection Young Adult Liver disease Predictive Value of Tests Severity of illness Living Donors medicine Humans Retrospective Studies Transplantation business.industry Liver Diseases Retrospective cohort study Middle Aged Prognosis medicine.disease Liver Transplantation Surgery Portal vein thrombosis ROC Curve Predictive value of tests Female business Abdominal surgery |
| Zdroj: | Transplantation Proceedings. 52:1299-1302 |
| ISSN: | 0041-1345 |
| DOI: | 10.1016/j.transproceed.2020.02.073 |
| Popis: | Living donor liver transplant (LDLT) is a well-established treatment for end-stage liver disease. A better recipient selection and hemodynamic evaluation may improve transplant outcomes. The aim of this study was to establish recipient parameters that could enhance the results of adult-to-adult LDLT.We performed a retrospective study of all adult-to-adult LDLTs from a single center between January 2006 and December 2018. Variables analyzed included demographic and clinical parameters, laboratory tests, performance of intraoperative temporary portocaval shunt (TPCS), graft weight/recipient weight ratio (GW/RW), preoperative portal vein thrombosis (PVT), previous major abdominal surgery, and patient survival. Patients were divided in 2 groups according to GW/RW (0.8% cutoff point).A total of 92 adult-to-adult LDLTs were analyzed, encompassing 53 male patients (57.6%). Mean Model for End-Stage Liver Disease score was 13.97 (SD, 4.74), and 57 patients (61.95%) had Child-Pugh-Turcotte score B. Mean GW/RW was 1.1% (SD, 0.37%). Group 1 with GW/RW0.8% (n = 74) and group 2 with it ≤ 0.8% (n = 13) presented mean GW/RW of 1.14% (SD, 0.24%) and 0.69% (SD, 0.09%) and P .01, respectively. Eighteen patients (19.56%) presented PVT, with a worse survival than those without PVT (P = .006). Sixteen patients (17.39%) with previous major abdominal or biliary operations also presented higher mortality (P = .341). Forty-six (50%) intraoperative TPCSs were performed with a better 1- and 3-year patient survival. Receiver operating characteristic curve analysis showed PVT area under the curve of 0.701 (95% CI, 0.526-0.876; P = .018), positive predictive value of 0.69, and negative predictive value of 0.62. Multivariate analysis showed important risk regarding PVT (odds ratio, 6.160; 95% CI, 1.566-24.223; P = .004) and retransplant (odds ratio, 4.452; 95% CI, 0.843-23.503; P = .06).Better recipient selection without PVT or previous major abdominal surgery, an adequate GW/RW, and intraoperative TPCS with hemodynamic modulation significantly improve outcomes of adult-to-adult LDLT. |
| Databáze: | OpenAIRE |
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