Right Lobe Living Donor Liver Transplantation for Adult Patients with Acute Liver Failure: A Single-Center Experience in Turkey

Introduction: Acute liver failure (ALF), a life-threatening clinical syndrome of sudden and severe liver dysfunction, is associated with a coagulation abnormality and hepatic encephalopathy in patients without previous clinically liver disease. Therefore, ALF is very complicated status and the chance of spontaneous healing is poor. Liver transplantation (LT) is the only definitive treatment modality with well demonstrated efficacy for ALF patients. Right lobe living donor liver transplantation (RLDLT) is an excellent option for adult patients with ALF in cadeveric donor shortage. We analyzed the etiologies and our experiences in adult patients who underwent emergency RLDLT for ALF. Methods: We evaluated the charts of adult patients with ALF underwent RLDLT at Turgut Ozal Medical Center (Malatya, Turkey) between January, 2007 and September, 2011. All of the ALF patients were identified by retrospective review of a prospectively acquired liver database that contained recipient and donor demographics, perioperative findings, and postoperative outcomes. Continuous variables are reported as means ± standard deviations, and categorical variables as numbers and percentages. Results: We performed 643 liver transplants including cadaveric and live donors, and of thirty adult patients 30 (4.7%) with ALF underwent RLDLT during this study period. The median age was 32,2±13.05 years. The etiologies of ALF in the RLDLT patients were acute hepatitis B in 11 (36.6%) patients, hepatitis A in 4 (13.3%), drug intoxication in 4 (13.3%), pregnancy in 2 (6.7%), hepatitis B with pregnancy in 1 and mushroom intoxication in one (3.3%), and 7 (23.3%) unknown etiologies. The mean of hepatic coma grade (Model for End-Stage Liver Disease scores) was 34.13± 8.72. Mean graft-to-recipient weight percentage was 1.3 ± 0.3%. Mean interval between indication for transplant and LT procedure was 19.7 ± 23.6 h. Mean cold ischemia time was 154.35 ± 59.6 min. Mean recipient operation time was 605 ± 120 min. The RLDLT patients had a higher biliary and vascular complication rate (40%, 20% respectively). Survival rate of RLDLT patients was 70%, nine deaths occurred due to pulmonary (n=2), cardiac (n=1), sepsis (n=2), encephalopathy (n=4) complications. The mean intensive care unit stay was 3.2 ± 2.3 days and the mean postoperative hospital stay was 29.5 ± 23 days for RLDLT patients. The mean follow-up times were 305 days (1-1582). All of the donors remained alive and well with normal liver function at the time of the final follow-up examination. Conclusions: Liver transplantation is potentially the only curative modality and has markedly improved the prognosis of ALF patients. The interval between onset of ALF and death is short and crucial because of progressive multi-organ failure at a rapid rate in addition to the liver. Therefore, RLDLT should be considered a life-saving procedure, characterized by quicker access to liver grafts and very short ischemia time, for adult patients with ALF in shortage of deceased donor. Declaration of Interest: The authors report no conflict of interest and no funding from any company.