Complementary Roles of Cadaveric and Living Donor Liver Transplantation in Acute Liver Failure

• Published in: Journal of gastrointestinal surgery Vol. 25; no. 10; pp. 2516 - 2523
• Main Authors: Özden, İlgin, Yavru, Hacer Aysen, Durmaz, Özlem, Orhun, Günseli, Salmaslıoğlu, Artür, Güllüoğlu, Mine, Alper, Aydın, İbiş, Cem, Serin, Kürşat Rahmi, Önal, Zerrin, Özcan, Perihan Ergin, Poyanlı, Arzu, Hançerli, Selda, Çağatay, Atahan, Cantez, Serdar, Kaymakoğlu, Sabahattin
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2021; Springer Nature B.V
• Subjects: Adolescent; Adult; Blood & organ donations; Cadaver; Child; Drug overdose; Gastroenterology; Hepatitis; Humans; Intensive care; Liver; Liver Failure, Acute - etiology; Liver Failure, Acute - surgery; Liver Transplantation; Liver transplants; Living Donors; Medicine; Medicine & Public Health; Original Article; Surgery; Wilson’s disease; Living donor; Mushroom poisoning; Cadaveric donor; Hepatitis A; Hepatitis B
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-021-04932-3

Background Living donor liver transplantation may complement cadaveric transplantation in acute liver failure (ALF) patients. Methods Between 2008 and 2017, 89 patients were treated for ALF; 15 patients (17%) recovered with intensive care treatment; 31 (35%) died without transplant. The records of the remaining 43 patients (median (range) age: 14 (1–62)) who underwent transplantation were evaluated. Results The etiologic factors were toxic agents (10; mushrooms: 8; herbs: 2), hepatitis viruses (7; A: 1; B: 6), Wilson’s disease (7), autoimmune hepatitis (4), and Budd-Chiari syndrome (2); 13 cases were idiopathic. Cadaveric organs (whole, split, reduced) were transplanted to 32 patients; 11 patients underwent living donor transplantation. One patient (2%) died of septic shock on the second postoperative day. Bacterial infection was the most common early (< 3 months) complication in the remaining patients (31/42; 74%), followed by delirium (5/42; 12%) and acute rejection requiring steroid pulse (5/42; 12%). Seven other patients died during median (range) follow-up of 94 (14–142) months: various infections (5), leukemia (1), and acute myocardial infarction (1). The 1-, 5-, and 10-year survival rates were 100%, 96%, and 92% in children and 94%, 82%, and 65% in adults respectively. Conclusions Cadaveric organ sharing and transplantation from living donors when appropriate yield a high survival rate, despite high early morbidity, in ALF patients whose conditions deteriorate despite intensive care treatment. Efforts to eliminate preventable causes of acute liver failure will lead to more efficient use of health care resources.