Experience from Vietnam and lessons learned in setting up a living donor liver transplant program

Abstract

Background: Living donor liver transplantation (LDLT) is the only treatment option for patients with end-stage liver disease (ESLD) where cadaveric donors are not available. In developing countries, the inception of LDLT programs remains a challenge. The first successful liver transplantation in Vietnam underwent in 2004. The objective of this study was to report outcomes of 140 LDLT recipients in a developing country and to highlight the challenges encountered by a new LDLT program in a resource-limited setting in highest-volume center in Vietnam. Methods: We retrospectively reviewed recipients who underwent LDLT between October 2017 and August 2022 in 108 Military Central Hospital. Demographics, etiology, graft characteristics, and operative variables were assessed. Outcome was assessed on the basis of morbidity and mortality. All complications of three on the Clavien-Dindo grading system were included as morbidity. Estimated 1-year, 3-year, 5-year survival was calculated using Kaplan-Meier curves, and a log-rank test was used to determine the significance. Outcomes between the first 80 LDLTs (group 1) and latter 60 LDLTs (group 2) were also compared. Results: Median age was 48.5 (11-80) years, whereas the median MELD score was 24 (7-37). The male to female ratio was 4:1. ACLF to hepatitis B virus was the most common indication (40% patients). There were 43 patients significant (grade 3) complications. The most common morbidities were bile leaks in eight and biliary strictures in 21 patients. Overall mortality in patients who underwent LDLT for ACLF was 15.7%. Estimated 1-year survival was 91%, 3 years 85%. Patients who underwent transplantation in the latter period had a significantly lower overall complication rate (36% vs. 68%; P=0.01). Conclusions: Comparable outcomes can be achieved in a new LDLT program in a developing country. Outcomes improve as experience increases.