Liver transplantation epidemiology and demographics: Difference between revisions

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==Overview==
==Overview==
'''Donor mortality'''
'''Incidence'''
* Acoording to United Network for Organ Sharing, 2753 adult LDLT and 1283 pediatric LDLT had been performed in the USA till February 2010.
* The most common indication for transplantation was primary sclerosing cholangitis (37.7%).


As of February 28, 2010, 2753 adult and 1283 pediatric LDLTs had been performed in the USA and reported to United Network for Organ Sharing. [1],
=== Survival rates ===
* Survival rates at 10 years was 70% for LDLT and 64% for DDLT. 
* For all recipients female gender and primary sclerosing cholangitis were associated with improved survival while dialysis and older recipient/donor age were associated with worse survival.
* LDLT recipients had longer total operative time and shorter total ischemia time median 98 minutes vs 487 minutes, than DDLT recipients.
* Intraoperative blood transfusion requirements were lower in LDLT compared to DDLT. 
* Smaller graft size has higher technical complexity, the graft and patient survival rates of patients with right-liverLDLT are not different from those of patients receiving whole-graft DDLT. 
* Critically ill adult recipients with advanced liver failure, high MELD scores, and numerous secondary complications have generally been reported to have worse outcomes with this procedure.  


among which were seven donor deaths (0.2%) [10 ]
=== Morbidity and mortality ===
* Seven donor deaths have been reported till 2010 in the USA and 19 deaths worldwide.
* The overall mortality rate of liver transplantation is of the order of 0.2–0.5%.
* The risk associated with left-lobe donation may be lower than that with right-lobe donation.
* The incidence of complications in the donor varies in the literature from 9 to 67%, but is likely in the 30% range.
* The Adult Living Donor Liver Transplantation Cohort Study reported a donor complication rate of 38%; 21% of donors had one complication and 17% had two or more.


By some reports, there have been 19 deaths worldwide [30]
=== Complications ===
Common complications include:
* Biliary leaks beyond postoperative day 7 (9%)
* bacterial infections (12%)
* incisional hernia (6%)
* pleural effusion requiring intervention (5%)
* neuropraxia (4%)
* reexploration (3%)
* wound infections (3%)
* Intraabdominal abscess (2%)


the overall mortality rate is of the order of 0.2–0.5%
==References==
 
the risk associated with left-lobe donation may be lower than that with right-lobe donation.
 
The incidence of complications in the donor varies in the literature from 9 to 67%, but is likely in the 30% range [31–36].
 
The Adult Living Donor Liver Transplantation Cohort Study
 
(A2ALL), funded by the National Institutes of Health, with nine livertransplant
 
centers, reported a donor complication rate of 38%; 21% of donors had one complication and 17% had two or more.
 
Common complications included biliary leaks beyond postoperative
 
day 7 (9%), bacterial infections (12%), incisional hernia (6%),
 
pleural effusion requiring intervention (5%), neuropraxia (4%), reexploration
 
(3%), wound infections (3%), and intraabdominal abscess (2%).
 
Two donors developed portal-vein thrombosis and one had inferior venacaval
 
thrombosis; 13% of donors required hospital readmission and 4%
 
required two to five readmissions [36].
 
Bile leaks and strictures have been reported in roughly 10 and 3%
 
of donors, respectively.
 
Living-donor recipients have been noted to have a higher incidence of surgical complications post-transplant compared with whole-liver recipients. [39]
 
Smaller graft size and higher technical complexity, the graft and patient survival rates of patients with right-liverLDLTare not different from those of patients receiving whole-graft DDLT [40,41].
 
The only difference is a higher incidence of biliary complications in the LDLT patients. [40]
 
Most centers have reported a 15–46% incidence of biliary complications, including early bile leaks, after transplant, and a 15–20% incidence of late biliary strictures.
 
These figures are significantly higher than are generally reported for whole-liver recipients (9–15%) [40]
 
the incidence of vascular complications such as hepatic artery thrombosis has decreased and is now not significantly different from that in deceased-liver transplants. [44–47]
 
Critically ill adult recipients with advanced liver failure, high MELD scores, and numerous secondary complications have generally been reported to have worse outcomes with this procedure. [40].
 
The epidemiology of infections after living donor liver transplantation (LDLT) is limited. 
 
We aimed to study the epidemiology and risk factors of infections after LDLT.
 
The most common indication for transplantation was primary sclerosing cholangitis (37.7%).
 
A total of 122 patients developed an infection during the follow-up period (1-year cumulative event rate of 56%), with the majority (66%) of these occurring within 30 days after transplantation.
 
Enterococcus sp. was the most frequent pathogen identified.
 
Survival probability at 10 years was 70% for LDLT and 64% for DDLT.
 
Post-transplant ICU days were less for LDLT.
 
For all recipients female gender and primary sclerosing cholangitis were associated with improved survival,
 
while dialysis and older recipient/donor age were associated with worse survival.
 
Higher MELD score was associated with increased graft failure. Era of transplantation and type of donated lobe did not impact survival in LDLT.
 
LDLT recipients had longer total operative time and shorter total ischemia time median 98 minutes vs 487 minutes, than DDLT recipients.
 
Intraoperative blood transfusion requirements were lower in LDLT compared to DDLT. 
 
==references==

Latest revision as of 20:04, 28 December 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

Liver trasnsplantation Microchapters

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Overview

Historical Perspective

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Choice of donor

Epidemiology and Demographics

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Complications

Acute rejection

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Post-surgical infection

Prognosis

Overview

Incidence

  • Acoording to United Network for Organ Sharing, 2753 adult LDLT and 1283 pediatric LDLT had been performed in the USA till February 2010.
  • The most common indication for transplantation was primary sclerosing cholangitis (37.7%).

Survival rates

  • Survival rates at 10 years was 70% for LDLT and 64% for DDLT.
  • For all recipients female gender and primary sclerosing cholangitis were associated with improved survival while dialysis and older recipient/donor age were associated with worse survival.
  • LDLT recipients had longer total operative time and shorter total ischemia time median 98 minutes vs 487 minutes, than DDLT recipients.
  • Intraoperative blood transfusion requirements were lower in LDLT compared to DDLT. 
  • Smaller graft size has higher technical complexity, the graft and patient survival rates of patients with right-liverLDLT are not different from those of patients receiving whole-graft DDLT.
  • Critically ill adult recipients with advanced liver failure, high MELD scores, and numerous secondary complications have generally been reported to have worse outcomes with this procedure.

Morbidity and mortality

  • Seven donor deaths have been reported till 2010 in the USA and 19 deaths worldwide.
  • The overall mortality rate of liver transplantation is of the order of 0.2–0.5%.
  • The risk associated with left-lobe donation may be lower than that with right-lobe donation.
  • The incidence of complications in the donor varies in the literature from 9 to 67%, but is likely in the 30% range.
  • The Adult Living Donor Liver Transplantation Cohort Study reported a donor complication rate of 38%; 21% of donors had one complication and 17% had two or more.

Complications

Common complications include:

  • Biliary leaks beyond postoperative day 7 (9%)
  • bacterial infections (12%)
  • incisional hernia (6%)
  • pleural effusion requiring intervention (5%)
  • neuropraxia (4%)
  • reexploration (3%)
  • wound infections (3%)
  • Intraabdominal abscess (2%)

References

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