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Clinical analysis of emergency liver transplantation: the role of living donor liver transplantation
Author(s) -
Kim SayJune,
Yoon YungChul,
Yoo YoungKyung,
Park JungHyun,
Kim DongGoo
Publication year - 2012
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2012.01634.x
Subject(s) - medicine , liver transplantation , hazard ratio , transplantation , liver disease , sepsis , retrospective cohort study , surgery , confidence interval , emergency department , gastroenterology , psychiatry
The current liver allocation system requires reevaluation because of the advancements in peri‐transplantation care and surgical techniques. And, the role of living donor liver transplantation ( LDLT ) in an emergency has not been determined yet. Retrospective review of all patients undergoing emergency liver transplantation ( LT ) from J anuary 2000 to J une 2010 was conducted, and clinical data were analyzed. Of the total 505 LT s, 69 patients (13.7%) underwent an emergency LT . Of these, 54 patients (78.3%) underwent LDLT using a right liver, and 15 patients (21.7%) underwent deceased donor liver transplantation ( DDLT ). The overall hospital mortality was 21.7% (15/69). The leading cause of death after transplantation was sepsis (60.0%). Multivariate analysis demonstrated that a model for end‐stage liver disease ( MELD ) >33 [hazard ratio ( HR ), 16.6; 95% confidence interval ( CI ), 1.443–191.632; p = 0.024] and existence of pre‐transplantation intubation ( HR , 18.2; 95% CI , 1.463–225.483; p = 0.024) were independent factors associated with poor survival after emergency LT . LDLT group and DDLT group showed no difference in hospital mortality (p = 0.854) and graft survival (p = 0.861). Thus, MELD score and respiratory insufficiency could be parameters predicting post‐transplant survival. And, LDLT using the right liver could be an appropriate alternative to DDLT in an emergency.