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Although risk factors for the long-term mortality of liver transplantation are well described, there is a lack of detailed study regarding these factors for adult living donor liver transplantation (LDLT).We retrospectively analyzed 528 adult LDLT recipients in our hospital. The risk factors were analyzed for overall deaths more than 5 years post-LDLT.Over the 20-year follow-up, 137 patients died. Patient survival at 1, 3, 5, and 10 years post-LDLT was 87.8%, 81.8%, 79.4%, and 72.8%, respectively. The independent risk factors for more than 5 years post-LDLT overall death were hepatocellular carcinoma recurrence (hazard ratio [HR], 38.9; P0.001), lymphoid de novo malignancy (HR, 47.2; P = 0.001), primary sclerosing cholangitis as primary diagnosis (HR, 11.5; P0.001), chronic rejection (HR, 6.93; P = 0.006), acute rejection (HR, 2.96; P = 0.017), and bile duct stenosis (HR, 2.30; P = 0.045).Not only malignancies and rejection but also bile duct stenosis and primary sclerosing cholangitis had significant impacts on late period post-LDLT mortality.

In living-donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC), it is important to predict not only who may be susceptible to recurrence but also who may survive longer. The neutrophil/lymphocyte ratio (NLR) is useful to properly assess the patient without decreasing the long-term survival after LDLT. In this study, we investigated the relationship between NLR and prognosis of patients with recurrent HCC after LDLT.In total, 167 LDLTs for HCC were enrolled in this study. Clinicopathologic factors for HCC recurrence after LDLT were investigated and prognostic factors were examined with respect to survival.The following factors were found to be significant in patients with HCC recurrence compared with the controls: α-fetoprotein ≧300 ng/mL, des-γ-carboxyprothrombin ≧300 mAU/mL, NLR ≧4, tumor number3, tumor size ≧5 cm, duration of last treatment of HCC to LDLT3 months, Milan criteria exceeded, histologic tumor number ≧10, histologic tumor size5 cm, poor differentiation, presence of histologic vascular invasion, adjuvant chemotherapy, and interferon therapy against patients with hepatitis C virus. Male sex, interferon therapy against patients with hepatitis C virus, α-fetoprotein ≧300 ng/mL at recurrence, NLR ≧4 at recurrence, and nonsurgical resection for recurrent HCC were significantly related to poor prognosis. The 3-year survival rate after recurrence was 0% in patients with NLR ≧4 and 43.6% in patients with NLR4. NLR was reelevated after LDLT in patients who later died; however, NLR gradually decreased in surviving patients.NLR at recurrence is a prognostic factor affecting survival after recurrence in LDLT for HCC.

Although early relaparotomy of the recipient after living-donor liver transplantation (LDLT) is a significant event, its causes, risk factors, and outcomes are still unclear.A retrospective analysis of 284 cases of adult-to-adult LDLT was performed.The incidence of early relaparotomy of the recipient was 9.2% (n=26). The reasons for relaparotomy were divided into three groups: postoperative bleeding (n=11, 42.3%), insufficient portal venous flow (n=5, 19.2%), and other (n=10, 38.5%). The 6-month graft survival rates of patients in the early laparotomy and nonlaparotomy groups were 61.5% and 88.4%, respectively (P0.0001). Patients with postoperative bleeding experienced a significantly higher mortality rate (54.6%) than those with other reasons for early relaparotomy (13.3%; P=0.0231). Multivariate analysis showed that a model for end-stage liver disease score of greater than 20 (odds ratio [OR], 9.06; P=0.0434) and an operative blood loss of greater than 15 L (OR, 9.06; P=0.0434) were significant risk factors for graft loss after early relaparotomy. In patients with patent major shunt vessels (1 cm in diameter, n=31), portal venous flow of less than 1.0 L/min at the end of surgery was a significant risk factor for early relaparotomy to ligate the remaining shunt vessels (OR, 50.5; P=0.0188).Early relaparotomy of the recipient is significantly associated with poor graft survival after LDLT. Massive intraoperative blood loss and high model for end-stage liver disease score were associated with poor graft survival in the relaparotomy group.

BACKGROUND It has not been addressed whether the major spontaneous portosystemic shunt vessels should be ligated in living-donor liver transplantation (LDLT). METHODS We performed a retrospective analysis of 324 cases of adult-to-adult LDLT. RESULTS Factors associated with the presence of major (>10 mm) shunt vessels (n=130) included portal vein (PV) thrombosis (27.7%), lower PV pressure at laparotomy, Child-Pugh class C, and transplantation of right-side grafts. The types of major portosystemic shunt vessels included splenorenal shunts (46.2%), gastroesophageal shunts (26.9%), mesocaval shunts (13.8%), and others (13.1%). Ligation of the major shunt vessels increased PV pressure (mean [SD], from 16.8 [3.9] mm Hg to 18.6 [4.3] mm Hg; P

BACKGROUND Right lobe (RL) grafts without middle hepatic vein for living donor liver transplantation (LDLT) result in congestion of recipients' livers and sometimes in unfavorable postoperative course. This study aimed to evaluate the feasibility of our new V5-drainage-preserved RL (VP-RL) graft. METHODS Based on a review of 49 donors' livers in a retrospective study using three-dimensional reconstruction-computed tomography volumetry, hepatic vein draining segment 4 (V4) anatomy was classified into three types: inferior V4 dominant (A); superior V4 dominant (B); and umbilical vein to left hepatic vein dominant (C). Differences in functional graft volume (GV) and remnant liver volume (RV) between VP-RL and modified RL (M-RL) grafts with all three types were evaluated. In a prospective study of actual 15 LDLT, the outcome of venous reconstruction and postoperative parameters with VP-RL grafts compared with M-RL grafts was analyzed. RESULTS In the retrospective study using three-dimensional reconstruction-computed tomography volumetry, in types B and C, functional GV of VP-RL was larger than that of M-RL (P

Background. Accurate preoperative imaging is an important aspect of patient evaluation before liver transplantatior for hepatocellular carcinoma (HCC) because the size and number of tumors are indicators of posttransplant prognosis This study aimed to evaluate the preoperative detectability of HCC and clarify the role of preoperative assessment or prognosis after living donor liver transplantation (LDLT). Methods. Eighty-one patients who underwent LDLT for HCC accompanied by liver cirrhosis were reviewed. A total of 149 nodules were pathologically diagnosed as HCCs. The pathologic findings were correlated with preoperative results from contrast-enhanced computed tomography, magnetic resonance imaging, and computed tomography with angiography. Results. The detectability of small HCCs (< 1 cm) and well-differentiated HCCs was significantly reduced. Forty-six of 81 cases were preoperatively judged to meet the Milan criteria, although 16 of these failed to meet the criteria according to postoperative pathologic examination. However, recurrence-free survival in the 16 cases was similar to that in the 30 cases who met the criteria. Conclusions. The preoperative diagnostic accuracy of radiologic imaging for small-sized, well-differentiated HCCs requires improvement. However, these undetected HCCs have little effect on prognosis after LDLT, and current imaging modalities therefore provide acceptable methods of preoperative LDLT evaluation.