A five-year liver transplant experience in Rostov Oblast

Abstract

Objective: to reflect on a 5-year experience in liver transplant surgery at the Rostov Regional Clinical Hospital. Materials and methods. Liver transplant was performed in Rostov Oblast in July 2015 for the first time. There were 52 liver transplant surgeries performed in the region by the end of February 2020. Cirrhosis due to viral hepatitis is the leading indication for liver transplantation in 33.3% of patients. The average age of recipients was 43.5 ± 15.8 years. Male recipients accounted for 59.6% of cases. Nine recipients got liver transplants from blood relatives, while 43 recipients received an organ from post-mortem donors. For two patients, liver graft was obtained by splitting the liver into two lobes using the in situ split technique. Results. The average duration of surgery was 5.14 ± 1.92 hours. Blood loss during surgery did not exceed 1400 ml. Up to 93% of lost blood was recovered using the reinfusion system. The need for red blood cell transfusion was observed in 48.1% of cases. Fresh frozen plasma was transfused in all cases. Early postoperative complications were observed in 15 patients (29.4%), and some of them had several complications simultaneously. Biliary and vascular complications, which were eliminated by minimally invasive methods and open surgeries, had a significant influence on liver transplant outcome. In-hospital mortality was 5.6%. The causes of death were intra-abdominal bleeding (1), portal vein thrombosis (1) and biliary sepsis (1). Four more people died in the long term after being discharged from hospital: lung cancer (1), graft rejection (1) and fungal sepsis (2). Conclusion. Liver transplant outcome depends on the skills and experience of the specialists implementing this program. Post-transplant in-hospital and long-term mortality depends on the presence and nature of complications, and on the possibility of early treatment.