Recipient Outcomes of Salvage Liver Transplantation Versus Primary Liver Transplantation: Systematic Review and Meta-Analysis

Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
Liver Transplantation (Impact Factor: 4.24). 11/2012; 18(11). DOI: 10.1002/lt.23521
Source: PubMed


BACKGROUND: Salvage liver transplantation (SLT; liver resection followed by liver transplantation) has been performed after primary liver resection for many years. However, the true outcomes and risks of SLT relative to primary liver transplantation (PLT) remain unclear. METHODS: We performed a systematic review and meta-analysis to evaluate the survival rate and incidence of postoperative complications of SLT recipients. Of the 2,799 references screened, seven eligible studies were identified. RESULTS: The meta-analysis results indicated no statistically significant difference in the overall survival rate between SLT and PLT, with the pooled relative risk being 0.99 (95% confidence interval (CI), 0.90 to 1.09, p = 0. 867) at 1 year, 0.97 (95% CI, 0.83 to 1.13, p = 0. 675) at 3 years and 0.96 (95% CI, 0.81 to 1.13, p = 0. 613) at 5 years. With respect to postoperative complications, the incidence of sepsis and biliary complication showed no statistically significant difference between SLT and PLT, but there was a significantly higher incidence of bleeding with SLT (relative risk, 2.84; 95% CI, 1.57 to 5.13; p = 0. 001). CONCLUSION: SLT has similar overall survival to that of PLT. Given the limited organ donor pool, SLT might be an acceptable therapy for patients undergoing primary liver resection for HCC. Liver Transpl, 2012. © 2012 AASLD.

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Available from: Zhiwei Li, Nov 17, 2015
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    • "Hwang et al. [1] also concluded that combinations of recipients with a prior hepatectomy and living donor liver grafts for salvage LT are feasible, suggesting that salvage procedures should be extended to LDLT. Although the most recent studies have shown that salvage does not increase the difficulty of surgery, the salvage LT group had a longer operative time, more intraoperative bleeding, and increased transfusion volume, particularly in cases of a prior major hepatectomy [5,8]. "
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    ABSTRACT: Salvage living donor liver transplantation (LDLT) after major hepatectomy has been considered a challenging procedure due to operative complexity. We report a successful case of salvage dual graft LDLT after right hepatectomy. A 48-year-old male was transferred to Daegu Catholic University Medical Center because of duodenal variceal bleeding. He underwent right hepatectomy due to hepatocellular carcinoma four years prior. We performed LDLT with dual graft from his wife and sister. During operation, portal vein anastomosis of the right lobe graft was performed using an interposing cadaveric iliac vein graft and the right gastroepiploic artery was anastomosed to the hepatic artery of the left lobe graft. Adequate graft inflow was demonstrated by postoperative imaging studies. He has been doing well with normal graft function for 31 months. Salvage dual graft LDLT could be undertaken successfully in patients with prior major hepatectomy under accurate preoperative planning and proper surgical techniques.
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    • "Previous studies have already showed comparable prognosis between recipients who underwent SLT and primary liver transplantation (PLT) [3], [4]. The meta-analysis by Hu et al. assessed seven eligible studies reporting their experiences on SLT and observed that the overall survival rates as well as major post-transplant complications were similar between SLT and PLT [5]. "
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    ABSTRACT: Salvage liver transplantation (SLT) has recently been proposed for recurrent hepatocellular carcinoma after liver resection; however, criteria for candidate assessment in SLT have not been thoroughly evaluated. We retrospectively analyzed outcomes and factors affecting survival of 53 recipients who received SLT in the Liver Transplantation Center, The First Affiliated Hospital of Zhejiang University between 2004 and 2012. Thirty recipients fulfilled the Hangzhou criteria, of which 16 also fulfilled the Milan criteria, while the remaining 23 exceeded both criteria. The 1-year, 3-year and 5-year overall survival rates and tumor-free survival rates were both superior in patients fulfilling Milan or Hangzhou criteria compared with those exceeding the criteria. For recipients outside Milan criteria but within Hangzhou criteria, the 1-year, 3-year overall survival rates were 70.1%, 70.1%, similar to recipients within Milan criteria, with the 1-year, 3-year and 5-year overall survival of 93.8%%, 62.1% and 62.1% (P = 0.586). The tumor-free survival rates were also similar between these two subgroups, with 51.9% and 51.9% vs. 85.6%, 85.6% and 64.2% during the same time interval, respectively (P = 0.054). Cox regression analysis identified Hangzhou criteria (within vs. outside, hazard ratio (HR) 0.376) and diameter of the largest tumor (HR 3.523) to be independent predictors for overall survival. The only predictor for tumor-free survival was diameter of the largest tumor (HR 22.289). Hangzhou criteria safely expanded the candidate pool and are feasible in assessment of candidates for SLT. This is helpful in donor liver allocation in transplant practice.
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