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Eun, Chang, Kim, Bo, Hong, Byoung, Sang, Jae, Lee, and Ik: Outcomes of Early Liver Transplantation in a Hospital That Is Starting to Perform Liver Transplantation
Original Article

J Korean Soc Transplant 2011;25(3):184-189.

Published online: 10 September 2011

DOI: https://doi.org/10.4285/jkstn.2011.25.3.184

Outcomes of Early Liver Transplantation in a Hospital That Is Starting to Perform Liver Transplantation

Kyoung Lee Eun, M.D.1, Seong-Hwan Chang, M.D.1, Duk-Kyung Kim, M.D.2, Sung Cheon Bo, M.D.1, Young-Sang Hong, M.D.1, Joon Kang Byoung, M.D.1, Eun Nam Sang, M.D.1, Hoon Sim Jae, M.D.1, Hae-Won Lee, M.D.1, Jin Yun Ik, M.D.1

1 Departments of Surgery, Konkuk University School of Medicine, Seoul, Korea

2 Departments of Surgery, Anesthesiology and Pain Medicine, Korea

3 Departments of Surgery, Konkuk University School of Medicine, Seoul, Korea

책임저자：장성환, 서울시 광진구 화양동 4-12건국대학교병원 외과, 143-729 Tel: 02-2030-7586, Fax: 02-2030-7749 E-mail: csh@kuh.ac.kr

Copyright © 2011 The Korean Society for Transplantation

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

In Korea, the number of liver transplantation (LT) center is still changing. Many more centers are performing liver transplantations than that during the past decades. But several centers have stopped liver transplantation, while some centers have newly started performing liver transplantation. We present our initial experience in a newly built center as an example for any center that is considering performing LT.

Methods

A total of 33 consecutive adult LTs that were performed from June 2006 to October 2009 were analyzed by comparing the first 11 living donor liver transplants (LDLTs) performed with the help of an outside experienced team (group 2) with the second 11 LDLTs (group 3) and the 11 deceased donor liver transplantations (DDLTs) cases (group 1) that were independently performed in our center.

Results

There was no operative mortality for the donors and there were two operative mortalities for the recipients. During a mean follow-up of 27.1 months (range: 2 days∼61 months), there were two cases of late mortality for the recipients. There were no re-operations and no major complications for the donors. The warm ischemic time was significantly longer in group 1 than that in groups 2 and 3. Otherwise, there was no significant difference in the operative outcomes among the three groups.

Conclusions

Thorough preparation and the valuable assistance of an experienced liver transplantation team at the beginning can facilitate a more rapid learning curve and bring about good outcomes even in a small, newly established institution.

Keywords: Liver transplantation, Learning curve, Treatment outcome

References

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Fig. 1.
Cumulative survival rates of the three groups. There was no significant difference among the three groups (P-value= 0.071).
jkstn-25-184f1.tif
Table 1.
Clinical characteristics of recipients
　 Group 1 (n=11) Group 2 (n=11) Group 3 (n=11) Total (n=33) P value
Gender (male： female) 8：3 8：3 7：4 23：10 0.877
Age (years; mean±SD) 44.7±7.8 51.4±4.4 47.5±5.4 47.9±6.5 0.049
Body weight (kg; mean±SD) 62.0±10.0 66.12±10.7 65.7±13.1 64.6±11.1 0.65
Original liver disease 　       　
Viral hepatitis 7 9 9 25 　
Others 4 2 2 8 　
Accompanying HCC 1 8 5 14 　
MELD socre (mean±SD) 30.09±9.3 18.6±8.8 19.4±8.5 22.7±10.1 0.08
≤18 1 7 6 14 　
19∼24 3 1 4 8 　
25∼30 1 2 0 3 　
≥30 6 1 1 8 　
Child-Pugh score 　       0.016
A (5∼6) 0 1 0 1 　
B (7∼9) 0 5 4 9 　
C (≥10) 11 5 7 23 　

Group 1, CDLT; Group 2, LDLT with help; Group 3, LDLT without help.

Table 2.
Outcomes of recipients
　 Group 1 (n=11) Group 2 (n=11) Group 3 (n=11) Total (n=33) P value
Operation time (minutes) 　       0.055
Mean±SD 9:25±1:15 10:16±1:36 11:02±1:36 10:14±1:36 　
Range 7:47∼12:05 7:23∼12:55 8:20∼13:42 7:23∼13:42 　
RBC transfusion 　       0.987
Mean±SD 9.7±5.3 9.6±9.6 10.1±7.9 9.8±7.5  
Range 2∼19.5 0∼28 2∼26 0∼28 　
Reoperation 2 1 0 3 　
Postoperative hospital stay (days; mean±SD) 27.8±13.6 42.5±46.6 25.4±11.5 32.0±28.9 0.332
Follow up (days) 　       ＜0.001
Mean±SD 730.5±483.7 1352.4±527.5 821.2±320.1 968.0±537.5 　
Range 2∼1,353 180∼1,847 6∼1,161 2∼1,847 　
Postoperative complications 　       　
Bleeding 2 1 0 3  
Biliary stricuture 0 1 1 2  
Vascular complications 2 1 0 3  
PCD insertion 1 1 1 3  
Infection 3 2 1 6  
Death 3 1 0 4  
Acute rejection 0 1 2 3  

Group 1, CDLT; Group 2, LDLT with help; Group 3, LDLT without help.

Table 3.
Characteristics and outcomes of living donors
　 Group 2 (n=11) Group 3 (n=11) P value
Gender (male： female) 9：2 7：4 0.362
Age (years; mean±SD) 28.6±11.6 23.9±7.3 0.275
Operation time (minutes) 　    
Mean±SD 5:23±44 5:40±55 0.443
Median 5:20 5:20 　
Postoperative 　   0.329
complications      
Bleeding 0 0 　
Biliary leakage 0 0 　　
Wound infection 1 0  
Reoperation 0 0  
Transfusion 0 0  
Postoperative hospital stay 13.9±5.6 10.8±2.0 0.099
(days; mean±SD)     　
Graft weight 746.0±93.0 692.3±137. 10.294
(g; mean±SD)      
GRWR (%; mean±SD) 1.14±0.15 1.08±0.22 0.43
Cold ischemic time     0.955
(minutes)      
Mean±SD 1:55±0:27 1:54±0.25  
Range 1:07∼2:34 1:14∼2:32  
Warm ischemic time     0.024
(minutes) 　    
Mean±SD 0:47±0:07 0:59±0:13 　
Range 0:34∼0:56 0:42∼1:19 　

Group 2; LDLT with help, Group 3; LDLT without help.

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