Advertisement

Indian Journal of Gastroenterology

, Volume 37, Issue 1, pp 18–24 | Cite as

Deceased donor liver transplant: Experience from a public sector hospital in India

  • Viniyendra Pamecha
  • Deeplaxmi Purushottam Borle
  • Senthil Kumar
  • Kishore Gurumoorthy Subramanya Bharathy
  • Piyush Kumar Sinha
  • Shridhar Vasantrao Sasturkar
  • Vibuti Sharma
  • Chandra Kant Pandey
  • Shiv Kumar Sarin
Original Article
  • 70 Downloads

Abstract

Background

Deceased donor liver transplant (DDLT) is an uncommon procedure in India. We present our experience of DDLT from a public sector teaching hospital.

Methods

A retrospective analysis of all DDLT was performed from April 2012 till September 2016. Demographics, intraoperative, donor factors, morbidity, and outcome were analyzed.

Results

During the study period, 305 liver transplants were performed, of which 36 were DDLT (adult 32, pediatric 4; 35 grafts; 1 split). The median age was 42.5 (1–62) years; 78% were men. The median donor age was 28 (1–77) years; 72.2% were men. About 45% of organs were procured from outside of Delhi and 67% of all grafts used were marginal. Three of 38 liver grafts (7.8%) were rejected due to gross steatosis. Commonest indication was cryptogenic cirrhosis (19.4%). The median model for end-stage liver disease sodium and pediatric end-stage liver disease scores were 23.5 (9–40) and 14.5 (9–22), respectively. Median warm and cold ischemia times were 40 (23–56) and 396 (111–750) min, respectively. Major morbidity of grade III and above occurred in 63.8%. In hospital (90 days), mortality was 16.7% and there were two late deaths because of chronic rejection and biliary sepsis. The overall survival was 77.8% at median follow up of 8.6 (1–54) months.

Conclusions

DDLT can be performed with increasing frequency and safety in a public sector hospital. The perioperative and long-term outcomes are acceptable despite the fact that most organs were extended criteria grafts.

Keywords

Diseased donor liver transplantation Marginal grafts Public sector hospital 

Notes

Compliance with ethical standards

Conflict of interest

VP, DPB, SK, KGSB, PKS, SVS, VS, CKP, and SKS declare that they have no conflicts of interest.

Ethics statement

The study was approved by the institute’s ethics review board and is in compliance with the Helsinki Declaration, 1964, and its subsequent modifications. Standard medical care was provided to all participants. Written informed consent in a standard format was obtained from all patients who underwent surgery. Since this was a retrospective study, participation in this study did not change the consent process or decision for surgery. Formal consent for participation in this study is therefore not required.

References

  1. 1.
    Narasimhan G, Kota V, Rela M. Liver transplantation in India. Liver Transpl. 2016;22:1019–24.CrossRefPubMedGoogle Scholar
  2. 2.
    Annual report 2015–2016. In: National Capital Region Planning Board. 2016. http://ncrpb.nic.in/pdf_files/Annual%20Report%202015-16.pdf. Accessed 15 Jan 2017
  3. 3.
    Organ Report. In: National Organ and Tissue Transplant Organization. 2014. http://www.notto.nic.in/organreport.htm. Accessed 15 Jan 2017.
  4. 4.
    Feng S, Goodrich NP, Bragg-Gresham JL, et al. Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant. 2006;6:783–90.CrossRefPubMedGoogle Scholar
  5. 5.
    Gruttadauria S, Cintorino D, Mandala’ L, et al. Acceptance of marginal liver donors increases the volume of liver transplant: early results of a single-center experience. Transplant Proc. 2005;37:2567–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Briceño J, Marchal T, Padillo J, Solórzano G, Pera C. Influence of marginal donors on liver preservation injury. Transplantation. 2002;74:522–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Briceño J, Solórzano G, Pera C. A proposal for scoring marginal liver grafts. Transpl Int. 2000;13 Suppl 1:S249–52.CrossRefPubMedGoogle Scholar
  8. 8.
    Briceno J, Lopez-Cillero P, Rufian S, et al. Impact of marginal quality donors on the outcome of liver transplantation. Transplant Proc. 1997;29:477–80.CrossRefPubMedGoogle Scholar
  9. 9.
    Briceño J, Padillo J, Rufián S, Solórzano G, Pera C. Assignment of steatotic livers by the Mayo model for end-stage liver disease. Transpl Int. 2005;18:577–83.CrossRefPubMedGoogle Scholar
  10. 10.
    Tisone G, Manzia TM, Zazza S, et al. Marginal donors in liver transplantation. Transplant Proc. 2004;36:525–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Adam R, Cailliez V, Majno P, et al. Normalised intrinsic mortality risk in liver transplantation: European Liver Transplant Registry study. Lancet. 2000;356:621–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Verran D, Kusyk T, Painter D, et al. Clinical experience gained from the use of 120 steatotic donor livers for orthotopic liver transplantation. Liver Transpl. 2003;9:500–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Nickkholgh A, Weitz J, Encke J, et al. Utilization of extended donor criteria in liver transplantation: a comprehensive review of the literature. Nephrol Dial Transplant. 2007;22 Suppl 8:viii29–36.PubMedGoogle Scholar
  14. 14.
    Bruzzone P, Giannarelli D, Adam R, European Liver and Intestine Transplant Association, European Liver Transplant Registry. A preliminary European Liver and Intestine Transplant Association-European Liver Transplant Registry study on informed recipient consent and extended criteria liver donation. Transplant Proc. 2013;45:2613–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Joya-Vazquez PP, Dodson FS, Dvorchik I, et al. Impact of anti-hepatitis Bc-positive grafts on the outcome of liver transplantation for HBV-related cirrhosis. Transplantation. 2002;73:1598–602.CrossRefPubMedGoogle Scholar
  16. 16.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Englesbe MJ, Merion RM. The riskiest job in medicine: transplant surgeons and organ procurement travel. Am J Transplant. 2009;9:2406–15.CrossRefPubMedGoogle Scholar
  18. 18.
    Routh D, Sharma S, Naidu CS, Rao PP, Sharma AK, Ranjan P. Comparison of outcomes in ideal donor and extended criteria donor in deceased donor liver transplant: a prospective study. Int J Surg. 2014;12:774–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Godara R, Naidu CS, Rao PP, et al. Use of marginal grafts in deceased donor liver transplant: assessment of early outcomes. Indian J Gastroenterol. 2014;33:136–40.CrossRefPubMedGoogle Scholar

Copyright information

© Indian Society of Gastroenterology 2017

Authors and Affiliations

  • Viniyendra Pamecha
    • 1
  • Deeplaxmi Purushottam Borle
    • 1
  • Senthil Kumar
    • 1
  • Kishore Gurumoorthy Subramanya Bharathy
    • 1
  • Piyush Kumar Sinha
    • 1
  • Shridhar Vasantrao Sasturkar
    • 1
  • Vibuti Sharma
    • 2
  • Chandra Kant Pandey
    • 3
  • Shiv Kumar Sarin
    • 4
  1. 1.Department of Liver Transplantation and Hepatopancreaticobiliary SurgeryInstitute of Liver and Biliary SciencesNew DelhiIndia
  2. 2.Department of Transplant CoordinationInstitute of Liver and Biliary SciencesNew DelhiIndia
  3. 3.Department of AnesthesiaInstitute of Liver and Biliary SciencesNew DelhiIndia
  4. 4.Department of HepatologyInstitute of Liver and Biliary SciencesNew DelhiIndia

Personalised recommendations