Technical Variant Outcomes in Adult and Pediatric Liver Transplantation, A Two Center Combined Experience
Manuel Rodriguez-Davalos2, *Christopher Ibarra2, *Fermin Fontan1, *Armando S. Munoz-Abraham2, *Brendan Kimball1, *Pamela Valentino2, *Michael Schilsky2, *Udeme Ekong2, *Sukru Emre2, James Markmann1, David C. Mulligan2, *Heidi Yeh1
1Massachusetts General Hospital, Boston, MA;2Yale School of Medicine, New Haven, CT
Objective: To study the use of technical variant (TV) allografts from living (LD) and deceased donors (DD) and review surgical outcomes.
Design: Retrospective review at two institutions in the New England region.
Setting: Patients who received a liver transplant with a TV from October 2005-2016.
Patients 173 patients, 67.6% were adults (mean age 49.8 yo) and 32.4% pediatrics (mean age 5.9 yo). 50.9% were males.
Interventions: Out of 173 total patients, 117 (67.63%) received living donor grafts and 95 (54.91%) had duct-to-duct (D-D) biliary reconstruction.
Main Outcome Measure Patient, graft outcomes and surgical complications.
Results: Two thirds of our patients received TV grafts from LD. Graft types were 74 right lobes, 19 extended right lobes, 33 left lobes, 46 left lateral segments, and 1 mono-segment. Biliary complications (BC) were divided as strictures (13.87%), leaks (16.18%) and leak/stricture (2.31%). Biliary strictures were more common in adults who received a RL and had D-D anastomosis (13%). BC did not affect long-term graft nor patient survival. Vascular complications were seen in 7.51% of these hepatic artery stenosis accounted for 41%. 17.3% had other complications.
Conclusions Segmental allografts have become an essential component of the current liver donor pool. The use of TV has increased in the last decade and outcomes have improved with donor/recipient selection, surgical techniques, and collaboration between centers in our region. From our series, we observed that LD grafts had more BC when compared to DD TV. D-D biliary reconstructions had a higher incidence of strictures over RNY. RNY were more common in pediatric with less complications. The overall results confirm the importance of using TV to decrease waitlist mortality.
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