Reuters Health Information: Liver transplant more than just "swapping out a carburetor"
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
"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
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
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
"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.