Evaluation of 100 patients for living donor liver transplantation

Abstract

The initial success of living donor liver transplantation (LDLT) in the United States has resulted in a growing interest in this procedure. The impact of LDLT on liver transplantation will depend in part on the proportion of patients considered medically suitable for LDLT and the identification of suitable donors. We report the outcome of our evaluation of the first 100 potential transplant recipients for LDLT at the University of Colorado Health Sciences Center (Denver, CO). All patients considered for LDLT had first been approved for conventional liver transplantation by the Liver Transplant Selection Committee and met the listing criteria of United Network for Organ Sharing status 1, 2A, or 2B. Once listed, those patients deemed suitable for LDLT were given the option to consider LDLT and approach potential donors. Donors were evaluated with a preliminary screening questionnaire, followed by formal evaluation. Of the 100 potential transplant recipients evaluated, 51 were initially rejected based on recipient characteristics that included imminent cadaveric transplantation (8 patients), refusal of evaluation (4 patients), lack of financial approval (6 patients), and medical, psychosocial, or surgical problems (33 patients). Of the remaining 49 patients, considered ideal candidates for LDLT, 24 patients were unable to identify a suitable donor for evaluation. Twenty-six donors were evaluated for the remaining 25 potential transplant recipients. Eleven donors were rejected: 9 donors for medical reasons and 2 donors who refused donation after being medically approved. The remaining 15 donorrecipient pairs underwent LDLT. Using our criteria for the selection of recipients and donors for LDLT gave the following results: (1) 51 of 100 potential transplant recipients (51%) were rejected for recipient issues, (2) only 15 of the remaining 49 potential transplant recipients (30%) were able to identify an acceptable donor, and (3) 15 of 100 potential living donor transplant recipients (15%) were able to identify a suitable donor and undergo LDLT. Recipient characteristics and donor availability may limit the widespread use of LDLT. However, careful application of LDLT to patients at greatest risk for dying on the waiting list may significantly reduce waiting list mortality. (Liver Transpl 2000;6:290-295.)

Comparação entre o custo do transplante hepático cadavérico e o intervivos

“…Neste aspecto, o transplante hepático com doador vivo apresenta uma importante vantagem com relação ao doador cadavérico. O transplante hepático com doador vivo é realizado mais precocemente, quando o paciente está menos debilitado 23 . Atualmente, o tempo em lista para transplante hepático no Brasil e na maioria dos países desenvolvidos é de três a quatro anos, enquanto que a espera para transplante com doador vivo é geralmente inferior a quatro a seis meses 2,16 .…”

“…O custo relativo à avaliação do doador vivo também deve ser considerado 23,25 . A avaliação do doador requer a realização de vários exames para se certificar da qualidade e compatibilidade de tamanho do fígado e ausência de doenças transmissíveis e de anomalias congênitas biliares e vasculares que impeçam a realização do transplante com segurança 23,24 .…”

“…A avaliação do doador requer a realização de vários exames para se certificar da qualidade e compatibilidade de tamanho do fígado e ausência de doenças transmissíveis e de anomalias congênitas biliares e vasculares que impeçam a realização do transplante com segurança 23,24 . Muitos destes exames, como arteriografia, ressonância magnética e biópsia hepática, são caros.…”

“…São também essenciais exames que permitam excluir doenças que possam colocar em risco a vida do doador. Até 40% dos candidatos à doação são excluídos durante o processo de avaliação 23 . Na nossa avaliação, 19% dos candidatos não foram aceitos para doação.…”

Treatment of patients with hepatitis C virus on the waiting list

“…In our center, approximately one-third of cases of adult LDLT are performed in patients infected with hepatitis C. One could argue that the widespread application of LDLT could be the answer for the imbalance between cadaveric donor supply and increasing number of recipients with hepatitis C. However, as few as 15% of potential recipients are eligible, have an identifiable donor, and actually undergo LDLT. 3,4 Even with marked changes in selection process, fewer that 25% of potential recipients will undergo LDLT.…”