Adult-to-adult living donor liver transplantation for acute liver failure in China

Table 1 The characteristics of recipients with acute liver failure

Parameters	Recipients (n = 20)
Preoperative
Age (yr)	39.5 ± 7.3
Gender (male/female)	17/3
BMI (kg/m2)	23.4 ± 3.4
SLV (cm3)	1339.7 ± 147.5
Etiologies (n)
Hepatitis B	18
Drug induced	1
Indeterminate	1
MELD scores	37.1 ± 8.6
Total bilirubin (μmol/L)	456.1 ± 207.3
Creatinine (μmol/L)	136.7 ± 102.1
INR	4.18 ± 3.42
Hepatorenal syndrome (n)	4
Waiting duration (d)	5 ± 4
Intraoperative
Graft volume (cm3)	618.3 ± 111.0
Graft weight(g)	623.3 ± 111.3
GV/SLV	46.2% ± 7.2%
GRWR	0.95% ± 0.14%
Graft type (n)
Right lobe	17
Dual graft	3
Cold ischemia time (min)	131 ± 24
Anhepatic phase time (min)	95.3 ± 24.9
Operation time (h)	11.5 ± 3.1
Blood loss (mL)	2700 (1000-7000)
Postoperative
Hospital stay (d)	33.7 ± 18.5
Death in hospital (n)	7
Follow-up (d)	425 (1-1654)

BMI: Body mass index; GRWR: Graft-to-recipient weight ratio; GV/SLV: Graft volume to recipient standard liver volume; MELD: Model for end-stage liver disease; INR: International normalized ratio.

Table 2 Classification of common complications of the recipients

Clavien grade		Complications	n
GradeI(n = 2)		Pleural effusion (mild)	1
		Anastomotic stoma stenosis of right hepatic vein without treatment	1
Grade II (n = 10)
	IIa	Pleural effusion (server) using pleurocentesis	1
		Transfusion 4 foreign blood units and pleural effusion (mild)	2
		A persistent elevated prothrombin time > 20 over 3 d	1
		Transient increase in creatinine levels (> twice the pretransplantation level) for one month	1
	IIb	Bile duct stricture corrected by endoscopic therapy, and pulmonary infection	1
		Hepatic artery thrombus requiring surgery, and bile leakage requiring endoscopic procedure	1
		Postoperative bleeding requiring laparotomy	1
Grade III (n = 0)		None	0
Grade IV (n = 7)		Renal failure and/or hepatic function failure	5
		Pulmonary infection	1
		Abdominal infection from bile leakage	1
Total			17

Table 3 Univariate analysis of the mortality in the acute liver failure cases

Variables	P value	Variables	P value
Gender	0.037	Outflow reconstruction	0.924
Age	0.442	Urine volume	0.291
BMI	0.914	Blood loss	0.608
Child-Pugh scoring	0.963	Operation duration	0.536
MELD scoring	0.727	Re-warm ischemia	0.394
MELD scoring grade (> 30)	0.306	Pre_TB	0.878
Waiting duration	0.014	Pre_Cre	0.563
GV/SLV	0.396	Pre_INR	0.670
GW/BW	0.385	POD1_TB	0.622
Anhepatic phase	0.620	POD1_Cre	0.021
Cold ischemia	0.767	POD1_INR	0.930

GV/SLV: Graft volume to recipient standard liver volume; GW/BW: Graft weight to recipient body weight; MELD: Model for end-stage liver disease; BMI: Body mass index; Pre: Preoperative; POD1: One of postoperative day one; TB: Total bilirubin; INR: International normalized ratio.

Table 4 The characteristics of living donors

Parameters	Donors (n = 23)
Preoperative
Age (yr)	37.7 ± 10.2
Gender (male/female)	8/15
BMI (kg/m2)	23.8 ± 3.5
Relationship with recipient (n)
Siblings	12
Daughter	4
Wives	5
Father	1
Uncle	1
Assessment time (d)	2.1 ± 1.3
Intraoperative
Graft steatosis (normal/mild)	18/5
Graft type (right lobe/left lobe)	20/3
RLV/TLV (%)	56.5 ± 12.1
Operation time (h)	6.9 ± 1.4
Blood lost (mL)	665.2 ± 480.9
Postoperative
Hospital stay (d)	13.4 ± 3.5
Peak of TB (μmol/L)	53.4 ± 22.7
Peak of INR	1.71 ± 0.36
Complications (n)	11
GradeI(n = 7)
Pleural effusion (mild)	4
Hepatic function impairment (mild)	2
Hepatic cut-section local fluid collection	1
Grade II (n = 3)
Pleural effusion (moderate) leading to partial compression atelectasis and hepatic function impairment (mild)	1
Pleural effusion (moderate) and pericardial effusion	1
Pulmonary infection undergone antibiotic therapy and hepatic function impairment (moderate)	1
Grade IIIa (n = 1)
Pleural effusion (server) using pleurocentesis	1

Hepatic function impairment: Mild, hyperbilirubinemia (TB being 51-85 μmol/L for more than 3 d or 34-51 μmol/L on POD7) and/or PT prolongation (6-8 s for more than 3 d or 4-6 s on POD7); Moderate, hyperbilirubinemia (TB > 85 μmol/L for more than 3 d or exceeding 51 μmol/L on POD7) and/or PT prolongation (> 8 s for more than 3 d or exceeding 6 s on POD7). BMI: Body mass index; RLV: Remanet live volume; TLV: Total liver volume; TB: Total bilirubin; INR: International normalized ratio; PT: Prothrombin time.

Table 5 Adult-to-adult living donor liver transplantation for acute liver failure between 2000 and 2010

Study	Recipient									Donor complications
	Cases	MELD	Waiting time (d)	Graft type			GV/SLV (%)	Mortality	Survival rate, n (%)	Cases	Minor	Major	Morbidity
				Right	Left	Dual
Park et al[2]	40	36	2.5	35	0	6	ND	6	1 (85)	45	11	0	24.40%
Shi-Chun et al[3]	10	34.5 ± 2.1	3	10	0	0	56.7 (47.7-66.9)	2	2 (80)	10	4	0	40%
Ikegami et al[4,12]	44	24 ± 6	8 ± 6	12	32	10	22.8-56.8	10	1 (78.3); 3 (71.6)	44	15	0	34%
Campsen et al[5]	10	> 21	2.7	10	0	0	ND	3	1-5 (70)	10	5	0	50%
Matsui et al[13]	36 (4)1	22 ± 6	ND	18	16	0	46 (22-75)	4	1 (94); 5 (87)	36	1	1	5.60%
Rajekar et al[14]	15	32	ND	ND			ND	3	4 (80)	ND	ND	ND	ND
Lee et al[15]	57	32	2.4	33	9	15	27-81	10	1-5 (82)	72	ND	ND	ND
Liu et al[16]	32	36 ± 1.8	2.5	32	0	0	52 (33-87)	4	2 (88)	32	8	2	31.30%
Nishizaki et al[17]	15	ND	5	0	15	0	36.7 (23-54)	3	1 (80)	15	ND	ND	ND

¹Four pediatric recipients were not clarified from 36 cases in this report. Major complications of donors were defined as the Clavine grade III-IV. MELD: Model for end-stage liver disease; GV/SLV: Graft volume to recipient standard liver volume; ND: Not described. The latest report was as the summarized standard if multiple reports were from the same center and author.