Search

Introduction Living Donor Liver Transplantation (LDLT) has grown immensely in certain countries over the last few years, whereas in West the growth remains static and low volume. Donor morbidity following LDLT has been reported in the median range of 15%–30% in various studies. One of the limiting factor for the growth of LDLT has been the concerns with morbidity and mortality during a centres initial experience. We report the donor outcome from a small volume centre, so as to assess if there is an impact on volume with donor outcome. Methods Between June 2007 and December 2011, 25 LDLT procedures were carried out in our unit. The criteria for donor selection included age, fitness for surgery and remnant liver volume. Donor demographics, graft type, complications, length of stay and overall survival were extracted. Donor morbidity was assessed objectively using the modified Clavien-Dindo classification. Continuous variables are expressed as mean ± SD. Results The mean donor age was 38.4±11.0 years and donor BMI was 23.9±2.8 kg/cm 2 . Two donors were abandoned on table due to complex arterial and biliary anatomy respectively. The graft type was right lobe (n=12, 52.2%), left lateral lobe (n=10, 43.5%) and left lobe (n=1, 4.3%). The graft weight was 528.5±258.9 g. The morbidity was 21.7% (n=5). There were three Clavien grade II complications (wound infection, urinary infection and unknown sepsis needing antibiotics). One patient needed laparotomy for haemorrhage (Grade IIIb) and another patient had ultrasound guided drainage of subphrenic collection (Grade IIIa). None of our patients had any post-operative blood transfusion. The length of hospital stay was 7.9±2.8 days. At the end of median follow-up of 21.4 months, all our donors were alive, with no long-term morbidity. Conclusion Our experience shows that donor hepatectomy for Living Donor Liver Transplantation is a safe procedure in a small volume unit. Our donor morbidity of 21.7% is comparable or better than most high volume centres across the world. Number of procedures performed by the unit shouldn9t be an hindrance to the introduction of live donor liver programme. Competing interests None declared.

Introduction Obesity levels in the UK have risen over the years. Studies from the US and elsewhere have reported variable outcomes in terms of post liver transplant morbidity, mortality and graft survival in obese liver transplant recipients. There are no such reports from the UK. The aim of this study was to analyse the impact of BMI (Body Mass Index) on outcomes following adult liver transplantation. Methods Data were retrieved from a prospectively maintained institutional database from 1994 to 2009. Patients were stratified into four BMI categories established by the WHO: underweight ( 2 ), normal weight (18.5– 2 ), over weight (>25.0– 2 ) and obese (>30.0 kg/m 2 ). Primary outcome was to evaluate post-operative morbidity and secondary measures were overall patient and graft survival. Categorical variables were analysed by χ 2 , and continuous variables by one-way ANOVA (p Results 1400 adult transplants were identified. 1325 patients had height and weight measurements and were included in the study. The overall morbidity was higher in overweight (71.9%, p Conclusion This is the largest and the only reported UK series on BMI and outcome following liver transplantation. Overweight and obese patients have increased morbidity in terms of septic complications following liver transplantation, with consequent increased length of intensive care and hospital stay. Identifying these patients early and introduction of measures to reduce BMI should be considered to improve outcomes following liver transplantation. Competing interests None declared.

Introduction The impact of poor nutritional status on the outcome following liver transplantation in children is well recognised. Recently studies in adults and children have reported variable effects of obesity on post transplant morbidity and mortality. This study examines the impact of pretransplant body mass index (BMI) on the outcome of liver transplantation in the current era in consecutive children from a single centre. Methods Data were retrieved from a prospectively maintained institutional database from 1994 to 2009. Patients were stratified into five BMI categories established by the WHO according to their Z scores: severe thinness (−3), thinness (-2), normal weight (0), overweight (+2) and obese (+3). Primary outcome was to evaluate post-operative morbidity and secondary measures were overall patient and graft survival. Categorical variables were analysed by χ 2 , and continuous variables by one-way ANOVA. Kaplan–Meier curves were used to study patient and graft survival. Results 146 paediatric liver transplants recipients were identified, of which 132 patients with height and weight data were included. 12.2% of patients were underweight (Z score −2 and −3), 8.3% were overweight (Z score +2 and +3) and the remaining 79.5% were normal weight for age. The overall morbidity was higher in underweight recipients in comparison to normal weight (81.2% vs 42.8%, p=0.006). Post-operative septic events were common in underweight recipients in comparison to normal weight recipients (75.0% vs 25.7%, p Conclusion This is the only reported UK series on BMI and outcome following paediatric liver transplantation. Despite current standards of peritransplant management we have demonstrated increased overall morbidity in underweight patients, with increased rates of post-operative septic complications, longer ventilatory period, and increased length of intensive care stay. However, unlike earlier studies, patient and graft survival were not affected. This study does not demonstrate any effect of obesity on post transplant morbidity or mortality. Competing interests None declared.