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

Abstract

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.

Pre and post-liver transplant outcome of cirrhotic patients with acute on chronic liver failure

“…In the paper of Finkenstedt et al [ 12 ] patients who developed infections such as pneumonia and/or sepsis and those who received renal replacement therapy or mechanical ventilation were less likely to undergo LT. That is the reason why, in our LT Program, only patients that improved or recovered after an ACLF episode have been considered for LT. Also the donation rate in Romania is far behind the international rates and discrepancies between need and offer are still important despite the increased donation rate in the years 2015–2017. [ 17 – 19 ] However, in patients surviving an ACLF episode, time to LT was significantly lower compared to patients without ACLF on the WL in relation with the higher MELD scores of these patients compared to non-ACLF patients, concordant with an Austrian study. [ 12 ]…”

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

“…All candidates for LT were evaluated using standardized criteria based on general status, clinical symptoms, laboratory tests, imagery, MELD/PELD score, and liver tumor features replaced recently by the LIRADS score. Our protocol for managing the recipients prior to LT was previously described (15).…”

“…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.…”

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

“…Our policy for the extended criteria donors (ECD) was according to international recommendations (21), and was previously described (15).…”