Building a liver transplant program in a resource limited country: a 15-year retrospective analysis of 648 patients operated in the Romanian National Program

Popescu, Irinel; Ionescu, M; Brasoveanu, Vladislav; Hrehoreţ, Doina; Botea, Florin; Dorobanţu, Bogdan; Alexandrescu, Sorin; Grigorie, M.; Matei, Emil; Zamfir, Radu; Lungu, Vasile; Tulbure, D; Tomescu, Dana; Droc, Gabriela; Ungureanu, Daniela; Fota, Ruxandra; Popescu, Mihai; Popa, Laura; Gheorghe, Liana; Iacob, Speranţa; Pietrareanu, Corina; Voiculescu, M; Mihaila, Mariana; Micu, L.; Constantinescu, Sanda; Gheorghe, Cristian; Cotruta, Bogdan; Lupescu, Ioana Gabriela; Grasu, Mugur; Boroș, Mirela; Dumitru, Radu; Toma, Mihai; Paslaru, Liliana; Vlad, L; Constantinescu, Ileana; Dima, Ileana; Herlea, Vlad; Becheanu, Gabriel; Pecheanu, Catalin; Sasalovici, Daniela

doi:10.21614/jtmr-20-2-32

Cited by 3 publications

(4 citation statements)

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“…(Donate and save lives!) [9]. Secondary to this our donor pool is now characterized by older donors and a higher DRI but these data are similar to those reported by countries with long-standing transplant programs [10,11].…”

Section: Discussionsupporting

confidence: 80%

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The impact of donor liver graft quality on postoperative outcome in liver transplant recipients. A single centre experience

Tomescu

Popescu

Jipa

et al. 2016

Rom J Anaesth Int Care

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Introduction. The Donor Risk Index (DRI) has become a universal score for organ allocation in liver transplantation (LT) worldwide. The aim of this study was to evaluate the impact of liver graft quality measured by DRI, CIT, WIT and donor age on intraoperative hemodynamics (reperfusion syndrome) and early postoperative outcome, defined as initial graft poor function (within 3 days of LT), of deceased donor liver transplant (DDLT) recipients. Secondary end-points were the assessment of the impact of graft quality on the intraoperative and postoperative day 1 hemostasis (evaluated using ROTEM assay). Methods. We retrospectively analyzed 135 patients who underwent deceased-donor LT between January 2013 and December 2014. Patient demographic data (age, sex, cause of End-Stage Liver Disease), preoperative paraclinical data (total bilirubin, creatinine, serum sodium), severity of liver disease scores (Model for End-Stage Liver Disease -MELD and MELD-sodium), intraoperative blood loss and blood products transfusion, incidence of post reperfusion syndrome, postoperative biochemical data (including total bilirubin, hepatic transaminases, lactate levels) and outcome (initial graft poor function diagnosis) were noted. Donor characteristics including DRI, CIT, WIT and donor age were noted. Coagulation was assessed by rotational thromboelastometry (ROTEM) after reperfusion of the graft and on postoperative day 1 in order to determine the effects of liver graft quality on hemostasis. Results. Donor age has significantly correlated with decreased derived ROTEM parameters time to the maximum velocity of clot formation -MaxVt (p = 0.000), area under the curve (AUC) (p = 0.008) and maximum clot elasticity (MCE) (p = 0.018) although no difference in transfusion requirements has been observed. A longer CIT was associated with an increase in AST and ALT observed during the early postoperative period: day 1 ALT (p = 0.032) and AST (p = 0.008), day 2 ALT (p = 0.001) and AST (p = 0.001) and day 3 AST (p = 0.010) and ALT (p = 0.001). Higher DRI correlated with higher bilirubin levels measured on postoperative day 1 (p = 0.027) and 2 (p = 0.001). Patients who developed initial graft poor function received liver grafts from older donors (p = 0.05) with a higher DRI (p = 0.002). Conclusion. Our results suggest a significant impact of donor age and DRI on perioperative coagulation kinetics that may be a result of initial graft poor function. Although CIT and DRI correlated with a more severe cholestasis and hepatocitolysis during the early postoperative period these seems to be short-lived.

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Section: Discussionsupporting

confidence: 80%

“…An overwhelming increase in donors and transplants have taken place in the last 2 years, with a peak of 122 liver transplants in 2013, which represented an almost two-fold increase compared to year 2012 with 75 transplants [9]. However, our results are based only from data collected between January 2013 and December 2014.…”

Section: Discussionmentioning

confidence: 91%

The impact of donor liver graft quality on postoperative outcome in liver transplant recipients. A single centre experience

Tomescu

Popescu

Jipa

et al. 2016

Rom J Anaesth Int Care

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“…Of note, in whole graft LT, for venous reconstruction we used the triangular cavo-cavostomy as standard technique (15), that replaced the techniques described by the Starzl and Belghiti (initially used, till 2003) (20). For bile duct reconstruction, we used choledococholedocal anastomosis without T-tube biliary drainage as standard technique; the use of the T-tube was abandoned after our initial experience.…”

Section: Materials and Methods Materials And Methodsmentioning

confidence: 99%

“…The used immunosuppressive regimens were according to the international recommendations and were previously described (15,20).…”

Section: Immunosuppressionmentioning

confidence: 99%

A Combined Program of Cadaveric and Living-Related Liver Transplantation in a Single Center: An Experience of 1,000 Operations

Botea¹,

Dorobanţu²,

Alexandrescu³

et al. 2021

SGO

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Background:The liver transplantation program of Fundeni Clinical Institute reached a milestone (1000 operations performed by the same team in 20 years). It is a program for both adults and children, including cadaveric and living donor liver transplantations. We analyze the indications and results to emphasize the advantages of a combined program. Methods: Between April 2000 and March 2020, 957 patients received 1,000 LTs at a single institution (Fundeni Clinical Institute, Bucharest, Romania). The demographics of donors and recipients, indications for liver transplantations, surgical procedures and results were analyzed. Results: Deceased donor liver transplantation (DDLT): 831 DDLTs in 790 patients (83.1%): whole LT in 769 patients (80.4%), split LT in 17 patients (2%), reduced-size LT in 2 patients (0.5%), auxiliary LT in 1 patient (0.1%) and domino LT in 1 patient (0.1%). Living donor liver transplantation (LDLT): 169 LDLTs in 167 patients (17.2%) using right hemiliver in 121 patients (12.6%), left lateral section in 28 patients (2.9%), left hemiliver in 9 patients (0.9%), left hemiliver with segment 1 in 6 patients (0.6%), and dual graft LDLT in 3 patients (0.3%). Overall major morbidity rate was 42.2% (422 patients), while perioperative mortality was 8.3% (79 patients). Retransplantation rate was 4.5% (43 patients). The estimated 1-, 3-, 5and 10-year overall survival rates for LT patients were 82.3%, 77.8%, 76.3% and 71.2%, respectively. Conclusions: A combined cadaveric and living donor LT program including all surgical variant LT procedures offers the possibility to increase the volume with the well-known consequences on the postoperative results. The living donor program has a positive influence on the waiting list mortality; using both cadaveric and living donors enhance the possibilities in the case of an urgent retransplantation.

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The Romanian National Program for Liver Transplantation - 852 Procedures in 815 Patients over 17 Years (2000-2017): A Continuous Evolution to Success

Popescu¹,

Ionescu²,

Brasoveanu³

et al. 2017

chr

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Liver transplantation (LT) has become an established treatment for end-stage liver disease, with more than 20.000 procedures yearly worldwide. The aim of this study was to analyze the results of Romanian National Program of LT. Between April 2000 and April 2017, 817 pts received 852 LTs in Romania. Male/female ratio was 487/330, while adult/pediatric ratio was 753/64, with a mean age of 46 years (median 50 yrs; range 7 months - 68 yrs). Main LT indications were HBV cirrhosis (230 pts; 28.2%), HCC (173 pts; 21.2%), and HCV cirrhosis (137 pts; 16.8%). Waiting time and indications for LT, patient and donor demographics, graft features, surgical procedures, and short and long-term outcomes were analyzed. DDLT was performed in 682 pts (83.9%): whole LT in 662 pts (81%), split LT in 16 pts (2.3%), reduced LT in 2 pts (0.2%), and domino LT in 1 pts (0.1%). LDLT was performed in 135 pts (16.5%): right hemiliver in 93 pts (11.4%), left lateral section in 28 pts (3.4%), left hemiliver in 8 pts (1%), left hemiliver with segment 1 in 4 pts (0.5%), and dual graft LDLT in 2 pts (0.2%). Overall major morbidity rate was 31.4% (268 pts), while perioperative mortality was 7.9% (65 pts). Retransplantation rate was 4.3% (35 pts): 27 whole LTs, 3 reduced LTs, 3 split LTs, and 2 LDLT. Long-term overall 1-, 3-, and 5-year estimated survival rates for patients were 87.9%, 81.5%, and 79.1%, respectively. One-, 3-, and 5-year overall mortality on waiting list also decreased significantly over time from 31.4%, 54.1% and 63.5%, to 4.4%, 13.9% and 23.6%, respectively. The Romanian National program for liver transplantation addresses all causes of acute and chronic liver failure or liver tumors in adults and children, using all surgical techniques, with good long-term outcome. The program constantly evolved over time, leading to decreased mortality rate on the waiting list.

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Building a liver transplant program in a resource limited country: a 15-year retrospective analysis of 648 patients operated in the Romanian National Program

Cited by 3 publications

References 31 publications

The impact of donor liver graft quality on postoperative outcome in liver transplant recipients. A single centre experience

The impact of donor liver graft quality on postoperative outcome in liver transplant recipients. A single centre experience

A Combined Program of Cadaveric and Living-Related Liver Transplantation in a Single Center: An Experience of 1,000 Operations

The Romanian National Program for Liver Transplantation - 852 Procedures in 815 Patients over 17 Years (2000-2017): A Continuous Evolution to Success

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