Vol. 7, No. 2 2003
six (54.6%) non-functioning tumors, 3 (27.3%) carcinoids, and 2 (18.2%) VIPomas. There were 4 (36.4%) men and 7 (63.6%) women with a mean age of 51.26.3 years. Three patients had distal pancreatectomies and 1 patient had a Whipple procedure at the time of transplant. Three patients had prior distal pancreatectomies, three had prior intestinal resections and 1 patient’s tumor was an incidental finding in the explant after transplant. The 1 and 5-year survival among these patients is 73% and 36%, respectively (range 0-119 months), with a median follow-up of 62 months. Of the 3 patients surviving 5 years, only 1 was disease free. Conclusion: In carefully selected patients with biologically favorable (i.e., less aggressive) metastatic neuroendocrine tumors, liver transplantation may be an appropriate option. Long-term survival is possible in these patients, however, cure is highly unlikely.
50 Efficiency of Recipient Screening and Donor Evaluation in Adult Living Donor Liver Transplantation Burckhardt Ringe, Felix Braun, Ruben Canelo, Thomas Lorf, Drexel University College of Medicine, Philadelphia, PA; Georg-August-Universitaet Goettingen, Goettingen, Germany Living donor liver transplantation has become a valuable tool to overcome the shortage and limits of cadaveric organ donation, and it has been shown to significantly reduce the mortality in children while waiting for transplantation. To assess the efficiency of recipient screening and donor evaluation in our adult liver transplant program we reviewed our early learning phase. Since initiation of the living donor liver transplant program at our institution in March 2000 a total of 61 adult patients were listed for cadaveric donor liver transplantation with Eurotransplant. At this point of time, the option of living donation was discussed with 41/61 recipients (72 %). In principle, a potential living donor was available and identified in 16/41 patients (39 %), remained unclear in 15, and was not available in 10 cases, respectively. Meticulous donor evaluation following a four-step protocol with thorough workup of medical history, physical examination, extensive laboratory tests, magnetic resonance imaging studies, laparoscopy with liver biopsy, endoscopic retrograde cholangiography, arteriography, psychology and other consults was completed in 15/16 cases (94 %). One donor reconsidered living donation, and finally refused to complete the evaluation because the recipient suffering from primary sclerosing cholangitis and ulcerative colitis had developed a colon carcinoma in the meantime. Living donor right hemihepatectomy and partial transplantation were performed and completed in 14/15 patients (94 %). One procedure had to be aborted since the recipient developed a septic shock during the operation. Thus, 14 of all 61 recipients seen during this period of time were able to receive a living donor liver transplantation resulting in an efficacy rate of 23 %. This figure corresponds well with our preoperative waiting list mortality rate of 25 % before the start of the living donor program. Our preliminary experience which is well in accordance with data published from other centers demonstrates that recipient screening and identification of potential living donors as well as their evaluation is efficient, and can result in a significant increase of organ donors for liver transplantation thus reducing also the risk of adult patients to die before transplantation can be realized.
51 Living Donor Liver Transplantation : Is the Morbidity Underestimated? Fédérica Dondéro, Olivier Farges, Daniele Sommacale, Francois Durand, Alain Sauvanet, Jacques Belghiti, Hospital Beaujon, Clichy, France
Transplant units have unreliably evaluated donor outcome in LRLT, as evidenced by the wide incidence of complications identified in the medical literature and in the NIH survey. Health authorities are catching up by implementing registries world-wide. It remains however the responsibility of the medical community to promote accurate reporting of donor complications. Between January 1995 and August 2002, 102 living-related donors were operated in our centre including left lateral sectoriectomies (LLS30), left hepatectomies (LH35) and right hepatectomies (RH37, including 19 with the middle hepatic vein) as part of a pediatric (n58) or an adult (n44) transplantation. Donor and recipient operations were performed independently, without cross over. Donors included 45 women and 57 men with a mean age of 369 years (range, 18-73). All intra- and postoperative complications were recorded prospectively by a specialised liver surgeon not involved in either donor or recipient procedures. Patients underwent a medical and an independent psychological evaluation 6 and 12 months after surgery. Donor mortality was nil. Duration of surgery and blood loss were 37354 min and 577237 mL. These figures were not significantly influenced by the extent of resection. There was one serious intraoperative adverse event (displacement of right hepatic vein clamp). Incidence of surgical complications was 9% (6 biliary leaks including 4 that required percutaneous drainage, 1 abdominal hernia, 1 reoperation for chylous ascites and 1 reoperation for bleeding). Incidence of major medical complications was 12% (3 pneumonia, 3 pulmonary embolism, 1 pneumothorax, 1 compression of the brachial plexus, 2 symptomatic pleural effusions that required drainage and one significant but transient kidney failure). No patient experienced overt liver failure. Incidence of other complications revealed by the prospective postoperative assessment was 24% including asymptomatic pulmonary embolism in 3, asymptomatic large pleural effusions in 4, gastroparesis in 2 and 16 cases of fever 38.5. Several of these complications had not been previously recognized following liver resections for other indications. Overall incidence of complications was 45%. Overall duration of in-hospital stay was 123 days and was influenced by the extent of resection. Hospital readmission following initial discharge was required in 4 patients. One, 6 and 12 months after donation there is not evidence of major and important sequelae and all donors had normal liver tests. In conclusion the prospective inclusion of all events following liver donor resection revealed a high incidence of complications. Some of these complications have not been recognized or have been underestimated following resections for other indications.
52 Laparoscopic Procurement Model for Living Donor Liver Transplantation Ernesto Molmenti, Peter A Pinto, Robert A Montgomery, Bradley Ryan, William Roberts, Thomas Hsu, Parviz Kavoussi, Andrew S Klein, Louis R Kavoussi, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Bayview Medical Center, Baltimore, MD Introduction and Objectives: Noting the contribution to renal transplantation by the introduction of the laparoscopic approach to donor nephrectomy, we investigated the possibility of performing a laparoscopic hepatic lobe procurement with the goal of performing a live donor liver transplantation. We describe our technique and determine its feasibility for such a goal. Methods: The surgical technique was developed over a series of 12 adult female pigs and adapted in two human cadavers. The technique included pneumoperitoneum with CO2, mobilization of the liver, and transection of the parenchyma into right and left lobes with a cavitron ultrasonic aspirator. The vascular inflow and outflow structures (hepatic artery, portal vein, hepatic veins) of the anatomical specimen being procured were preserved undisturbed during the hepatic transection. No temporary