ABSTRACT
Long waiting list times in liver transplant programs in Saudi Arabia and unavailability of deceased donor transplantation in Egypt have led several patients to seek transplantation in China. All patients who received transplants in China and followed in three centers from January 2003-January 2007 were included. All patients' charts were reviewed. Mortality and morbidity were compared to those transplanted in King Faisal Specialist Hospital & Research Centre (KFSH&RC) during the same period. Seventy-four adult patients were included (46 Saudi nationals; 28 Egyptians). One-year and 3-year cumulative patient survival rates were 83% and 62%, respectively compared to 92% and 84% in KFSH&RC. One-year and 3-year cumulative graft survival rates were 81% and 59%, respectively compared to 90% and 84% in KFSH&RC. Compared to KFSH&RC, the incidence of complications was significantly higher especially biliary complications, sepsis, metastasis and acquired HBV infection posttransplant. Requirements of postoperative interventions and hospital admissions were also significantly greater. Our data show high mortality and morbidity rates in Saudi and Egyptian patients receiving transplants in China. This could be related to more liberal selection criteria, use of donation after cardiac death (DCD) donors or possibly more limited posttransplant care.
Subject(s)
Liver Transplantation/adverse effects , Medical Tourism , Postoperative Complications/etiology , Adult , Aged , Biliary Tract Diseases/etiology , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/surgery , China , Constriction, Pathologic/etiology , Death , Egypt , Female , Graft Survival , Hepatitis B/complications , Hepatitis B/surgery , Hepatitis C/complications , Hepatitis C/surgery , Humans , Liver Neoplasms/complications , Liver Neoplasms/surgery , Liver Transplantation/mortality , Male , Middle Aged , Retrospective Studies , Saudi Arabia/epidemiology , Tissue Donors , Treatment OutcomeABSTRACT
OBJECTIVES: To objectively evaluate outcomes after living donor hepatectomy. PATIENTS AND METHOD: Between November 2002 and August 2006, a total of 44 procedures were performed (35 right, eight left, and one aborted after surgical incision). The Clavien classification was used to record surgical complications as follows: grade I, alterations from the ideal postoperative course not requiring specialized pharmacological or surgical treatment; grade II, complications requiring specialized pharmacological treatment, blood transfusion, or total parental nutrition; grade III-a, complications requiring invasive intervention without general anesthesia; Grade III-b, requires general anesthesia; Grade IV-a, single organ dysfunction; Grade IV-b, multiorgan dysfunction; grade V, death; The suffix "d" indicated disability. In this study, grades I and II complications were considered minor, while grades III and V and any lasting disability, serious complications. RESULTS: Male/female ratio was 34/10; median age was 25 years (range, 18 to 42); median hospital stay was 6 days (range, 4 to 14); and only two donors required intraoperative blood transfusion. After a median follow-up of 529 days (range, 8 to 1354), a total of 28 morbidities were encountered in 17 donors (38.6%), including nine donors (20.4%) who had serious complications. Among the 28 donor morbidities, 18 were grade I complications; three were grade III-a complications; five were grade III-b complications; and two were grade IV-a complications. No death was encountered in our experience. CONCLUSIONS: In our experience, donor hepatectomy was not an entirely safe procedure; therefore, extreme care should always be given by the transplant teams to living donors to avoid any distressing morbidity or even, the less likely but more catastrophic, mortality.
Subject(s)
Hepatectomy , Living Donors , Tissue and Organ Harvesting , Adult , Child , Hepatectomy/adverse effects , Humans , Intraoperative Complications/classification , Intraoperative Complications/epidemiology , Liver Transplantation/statistics & numerical data , Retrospective Studies , Tissue and Organ Harvesting/adverse effects , Treatment OutcomeABSTRACT
OBJECTIVE: To present our experience with deceased donor liver transplantation (DDLT) and living-donor liver transplantation (LDLT) for autoimmune hepatitis (AIH). PATIENTS AND METHOD: Between April 2001 and November 2006, a total of 116 LT procedures were performed (73 DDLTs and 43 LDLTs) in 112 patients (4 retransplants). Of the 112 recipients, 16 patients (14.3%) were transplanted for AIH (15 DDLTs and 1 LDLT). All recipients received FK506- and steroid-based immunosuppressive regimens. RESULTS: The male/female ratio was 3/13, median age was 22 years (range, 15 to 35), and the median MELD score was 25 (range, 11 to 40). Arterial reconstruction was needed in four DDLTs due to severe steroid-induced angiopathy. After a median follow-up period of 530 days (range, 11 to 2016), the overall patient and graft survival rates were 93.8%. Only one patient died following LDLT due to primary graft nonfunction. Histopathologic recurrence was seen in three patients (18.7%) and was successfully treated by optimizing immunosuppression. Markedly elevated serum CA19-9 levels (median, 1069; range, 217 to 2855) was seen in four patients (28%), malignancy was ruled out and all patients normalized serum CA19-9 levels within the first 3 months posttransplant. Steroids withdrawal failed in all recipients and was always accompanied with almost immediate elevation of liver enzymes. CONCLUSIONS: In our experience, LT for AIH shows excellent long-term outcomes, patients are usually young women who present with acute deterioration and high MELD scores, and usually require long-term steroids to prevent rejection and disease recurrence. Some patients have markedly high CA19-9 in absence of malignancy. Some patients also have severe steroid-induced hepatic artery angiopathy necessitating arterial reconstruction during the transplant surgery.
