Jm. Millis et al., Primary living-donor liver transplantation at the University of Chicago - Technical aspects of the first 104 recipients, ANN SURG, 232(1), 2000, pp. 104-111
Objective To evaluate the impact of technical modifications on living-donor
liver transplants in children since their introduction in 1989.
Summary Background Data Although more than 4,000 liver transplants are perf
ormed every year in the United States, only approximately 500 are performed
in children. Living-donor liver transplantation has helped to alleviate th
e organ shortage for small children in need of liver transplantation. Few c
enters have amassed a sufficient number of cases to evaluate the impact of
the differ ent techniques used in pediatric living-donor liver transplantat
ion.
Methods From 1989 through 1997, 104 primary living-donor liver transplants
were performed at: the University of Chicago. Three phases of the living-do
nor liver transplant program can be defined based on the techniques of vasc
ular reconstruction: phase 1, November 1989 to November 1994 (n = 78); phas
e 2, November 1994 to January 1996 (n = 6); and January 1996 to present (n
= 20). The patients' charts were reviewed retrospectively. The incidence an
d type of vascular complications and patient and graft survival rates were
analyzed.
Results Although the demographics of the patients have not changed during t
he three phases of the living-donor liver transplant program, the outcomes
have improved. Without the use of conduits, the incidence of portal vein co
mplications has significantly decreased from 44% to 8%. The incidence of he
patic artery thrombosis has decreased from 22% to 0% with the use of microv
ascular techniques, The combined use of both techniques has led to a signif
icant increase in graft survival, from 74% to 94%.
Conclusions The living-donor liver transplant recipient operation has under
gone significant technical changes since its introduction in 1989. These ch
anges have decreased the vascular complications associated with this type o
f graft. Avoiding the use of vascular conduits and performing microvascular
hepatic artery anastomoses are the critical steps in improving graft survi
val.