TY - JOUR
T1 - Novel Benchmark for Adult-to-Adult Living-donor Liver Transplantation
T2 - Integrating Eastern and Western Experiences
AU - Li, Zhihao
AU - Rammohan, Ashwin
AU - Gunasekaran, Vasanthakumar
AU - Hong, Suyoung
AU - Chen, Itsuko Chih Yi
AU - Kim, Jongman
AU - Hervera Marquez, Kris Ann
AU - Hsu, Shih Chao
AU - Kirimker, Elvan Onur
AU - Akamatsu, Nobuhisa
AU - Shaked, Oren
AU - Finotti, Michele
AU - Yeow, Marcus
AU - Genedy, Lara
AU - Dutkowski, Philipp
AU - Nadalin, Silvio
AU - Boehnert, Markus U.
AU - Polak, Wojciech G.
AU - Bonney, Glenn K.
AU - Mathur, Abhishek
AU - Samstein, Benjamin
AU - Emond, Jean C.
AU - Testa, Giuliano
AU - Olthoff, Kim M.
AU - Rosen, Charles B.
AU - Heimbach, Julie K.
AU - Taner, Timucin
AU - Wong, Tiffany C.L.
AU - Lo, Chung Mau
AU - Hasegawa, Kiyoshi
AU - Balci, Deniz
AU - Cattral, Mark
AU - Sapisochin, Gonzalo
AU - Selzner, Nazia
AU - Bin Jeng, Long
AU - Broering, Dieter
AU - Joh, Jae Won
AU - Chen, Chao Long
AU - Suk, Kyung Suh
AU - Rela, Mohamed
AU - Clavien, Pierre Alain
N1 - Publisher Copyright:
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Objective: To define benchmark values for adult-to-adult living-donor liver transplantation (LDLT). Background: LDLT utilizes living-donor hemiliver grafts to expand the donor pool and reduce waitlist mortality. Although references have been established for donor hepatectomy, no such information exists for recipients to enable conclusive quality and comparative assessments. Methods: Patients undergoing LDLT were analyzed in 15 high-volume centers (≥10 cases/year) from 3 continents over 5 years (2016-2020), with a minimum follow-up of 1 year. Benchmark criteria included a Model for End-stage Liver Disease ≤20, no portal vein thrombosis, no previous major abdominal surgery, no renal replacement therapy, no acute liver failure, and no intensive care unit admission. Benchmark cutoffs were derived from the 75th percentile of all centers' medians. Results: Of 3636 patients, 1864 (51%) qualified as benchmark cases. Benchmark cutoffs, including posttransplant dialysis (≤4%), primary nonfunction (≤0.9%), nonanastomotic strictures (≤0.2%), graft loss (≤7.7%), and redo-liver transplantation (LT) (≤3.6%), at 1-year were below the deceased donor LT benchmarks. Bile leak (≤12.4%), hepatic artery thrombosis (≤5.1%), and Comprehensive Complication Index (CCI®) (≤56) were above the deceased donor LT benchmarks, whereas mortality (≤9.1%) was comparable. The right hemiliver graft, compared with the left, was associated with a lower CCI® score (34 vs 21, P < 0.001). Preservation of the middle hepatic vein with the right hemiliver graft had no impact neither on the recipient nor on the donor outcome. Asian centers outperformed other centers with CCI® score (21 vs 47, P < 0.001), graft loss (3.0% vs 6.5%, P = 0.002), and redo-LT rates (1.0% vs 2.5%, P = 0.029). In contrast, non-benchmark low-volume centers displayed inferior outcomes, such as bile leak (15.2%), hepatic artery thrombosis (15.2%), or redo-LT (6.5%). Conclusions: Benchmark LDLT offers a valuable alternative to reduce waitlist mortality. Exchange of expertise, public awareness, and centralization policy are, however, mandatory to achieve benchmark outcomes worldwide.
AB - Objective: To define benchmark values for adult-to-adult living-donor liver transplantation (LDLT). Background: LDLT utilizes living-donor hemiliver grafts to expand the donor pool and reduce waitlist mortality. Although references have been established for donor hepatectomy, no such information exists for recipients to enable conclusive quality and comparative assessments. Methods: Patients undergoing LDLT were analyzed in 15 high-volume centers (≥10 cases/year) from 3 continents over 5 years (2016-2020), with a minimum follow-up of 1 year. Benchmark criteria included a Model for End-stage Liver Disease ≤20, no portal vein thrombosis, no previous major abdominal surgery, no renal replacement therapy, no acute liver failure, and no intensive care unit admission. Benchmark cutoffs were derived from the 75th percentile of all centers' medians. Results: Of 3636 patients, 1864 (51%) qualified as benchmark cases. Benchmark cutoffs, including posttransplant dialysis (≤4%), primary nonfunction (≤0.9%), nonanastomotic strictures (≤0.2%), graft loss (≤7.7%), and redo-liver transplantation (LT) (≤3.6%), at 1-year were below the deceased donor LT benchmarks. Bile leak (≤12.4%), hepatic artery thrombosis (≤5.1%), and Comprehensive Complication Index (CCI®) (≤56) were above the deceased donor LT benchmarks, whereas mortality (≤9.1%) was comparable. The right hemiliver graft, compared with the left, was associated with a lower CCI® score (34 vs 21, P < 0.001). Preservation of the middle hepatic vein with the right hemiliver graft had no impact neither on the recipient nor on the donor outcome. Asian centers outperformed other centers with CCI® score (21 vs 47, P < 0.001), graft loss (3.0% vs 6.5%, P = 0.002), and redo-LT rates (1.0% vs 2.5%, P = 0.029). In contrast, non-benchmark low-volume centers displayed inferior outcomes, such as bile leak (15.2%), hepatic artery thrombosis (15.2%), or redo-LT (6.5%). Conclusions: Benchmark LDLT offers a valuable alternative to reduce waitlist mortality. Exchange of expertise, public awareness, and centralization policy are, however, mandatory to achieve benchmark outcomes worldwide.
KW - CCI
KW - benchmarks
KW - complications
KW - liver transplantation
KW - living-donor liver transplantation
KW - outcomes
UR - http://www.scopus.com/inward/record.url?scp=85171136097&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85171136097&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000006038
DO - 10.1097/SLA.0000000000006038
M3 - Article
C2 - 37477016
AN - SCOPUS:85171136097
SN - 0003-4932
VL - 278
SP - 798
EP - 806
JO - Annals of surgery
JF - Annals of surgery
IS - 5
ER -