Liver transplant more than just "swapping out a carburetor"

Last Updated: 2014-07-31

By Megan Brooks

NEW YORK (Reuters Health) - Long-term complications can plague recipients of liver transplantation, a new study shows.

It found that biliary and vascular complications are a challenge for recipients of living donor liver transplant (LDLT), while renal impairment, cardiac complications, and recurrent cirrhosis are more probable in recipients of deceased donor liver transplant (DDLT).

And not all complications resolve.

"I think some transplant physicians and patients may think of organ transplant as swapping out a carburetor - 'Oh my liver is failing, my kidney doesn't work, I'll swap it out,'" Dr. Ben Samstein, surgical director of the Living Donor Liver Transplant Program at Columbia University College of Physicians and Surgeons in New York City, noted in an interview with Reuters Health.

"Fundamentally, for anyone who is taking care of people with end-stage organ disease, we don't want the quality or quantity of their life to be marked by only one organ. On the other hand, doing a liver transplant does affect multiple areas of your life," he said.

Dr. Samstein and colleagues studied long-term complications of DDLT and LDLT in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study.

Dr. Samstein presented the study findings during the July 28 Plenary Session at the 2014 World Transplant Congress in San Francisco.

What's "unique" about the study, he said, "is that we looked at the totality of the experience for someone undergoing a liver transplant, what are the challenges they face not just immediately after surgery but many years after surgery. Many of the patients were followed for as long as 10 years."

The researchers had data on 471 recipients of DDLT and 565 recipients of LDLT.

Recipients of LDLT were more likely to be white and have cholestatic liver disease, whereas DDLT recipients were more likely to have hepatocellular carcinoma (HCC), be in the ICU, be on a ventilator, or have ascites.

More LDLT than DDLT recipients had a physiologic Model for End-Stage Liver Disease (MELD) score less than 21 at the time of the transplant (85% vs. 47%).

During follow up, at least one complication occurred in 70% of DDLT recipients and 73% of LDLT recipients.

Complications more probable in LDLT included bile leak, biliary stricture, hepatic artery thrombosis, and bacteremia.

In DDLT, ascites, intra-abdominal bleeding, cardiac complications, and recurrent cirrhosis were more probable.

There was a higher probability of grade 3 or 4 complications in LDLT recipients (28% vs. 20% at eight years; p=0.03), the researchers found.

Risk factors for grade 4 complications were donation after cardiac death, dialysis at transplant, ascites, and duration of operation, with no marked difference between DDLT and LDLT (hazard ratio, 0.89; p=0.60).

LDLT recipients were less apt to develop chronic kidney disease (HR, 0.41; p=0.02).

The vast majority of complications (95%) resolved in five years, with 86% of complications resolving in 12 months, with no statistical difference between DDLT and LDLT.

Biliary strictures, hernia, and vascular and psychological complications had the lowest probability of resolution within 12 months.

"Certain complications such as depression, anxiety, and hernia had a very low resolution," Dr. Samstein said. "If you developed a hernia, there was a significant chance that it would never be resolved. And if you developed depression, a substantial proportion" would continue to need medication for years, he explained.

"It's important for people undergoing a liver transplant to understand how it might affect their entire body, that recovery may be slow and that it may affect them for the rest of their lives," Dr. Samstein said.