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Four Years of Hepatic Transplantation in the Republic of Moldova
Abstract:
Ever since the first liver transplant in the Republic of Moldova in 2013 we have performed 30 liver transplantations, the first having been performed in collaboration with the surgical team from Romania, led by Professor Irinel Popescu. The serious deficit of available cadaveric organs has forced us to begin with right hemi-liver transplantation from a living donor. In one third of liver transplantations we used right hemi-liver graft from a living donor, and in 2/3 of cases whole liver graft was harvested from brain-dead donors. The indication for surgical intervention in most cases was hepatic cirrhosis of viral aetiology in terminal stages, three cases of hepatocellular carcinoma, and one case for each of primary biliary cirrhosis, drug-induced toxic hepatitis, and liver retransplantation caused by hepatic arterial thrombosis. 10 cadaveric grafts were harvested from elderly donors ( 65 years). In the early postoperative period, four recipients died (2 live donor graft recipients and 2 graft recipients from donors with brain death). Causes of death were: intracerebral haemorrhage in the early postoperative period - 1, acute graft rejection - 1, hepatic artery thrombosis - 1, primary graft dysfunction - 1. There were no deaths during the late postoperative period. Of the complications that occurred during the early postoperative period we can highlight acute graft rejection -2, hepatic arterial thrombosis - 1, intraabdominal postoperative haemorrhage - 1, hepatic artery thrombosis -1, biliary peritonitis - 1, primary graft dysfunction -1, seizures -1. Complications during the postoperative period: biliary peritonitis after choledochal drainage removal - 1, "small-for-size" - 2. The accumulated experience and the use of modern technologies has allowed us to reduce the postoperative mortality rate, as well as the rate of occurring complications, in order to transfer this surgical intervention from the category of exclusivity operations to the category of daily interventions.
Insights
Moldova
Area of Science:
- Hepatology
- Transplant Surgery
- Organ Donation
Background:
- The Republic of Moldova initiated liver transplantation in 2013.
- A significant shortage of cadaveric organs necessitated the use of living donors for partial liver grafts.
- The primary indication for liver transplantation was end-stage viral hepatic cirrhosis.
Purpose of the Study:
- To review the initial experience with liver transplantation in Moldova.
- To analyze the outcomes of both living donor and deceased donor liver transplants.
- To assess the feasibility of establishing liver transplantation as a routine procedure.
Main Methods:
- Retrospective analysis of 30 liver transplantations performed between 2013 and the study period.
- Utilized right hemi-liver grafts from living donors and whole liver grafts from deceased donors.
- Included analysis of indications, donor types, early and late postoperative complications, and mortality.
Main Results:
- 30 liver transplantations were performed, with 1/3 using living donors and 2/3 using deceased donors.
- Early postoperative mortality was 13.3% (4/30), with causes including hemorrhage, rejection, thrombosis, and primary graft dysfunction.
- Key early complications included graft rejection, hepatic artery thrombosis, hemorrhage, and biliary peritonitis. Late complications included biliary peritonitis and "small-for-size" syndrome.
Conclusions:
- Liver transplantation in Moldova has progressed from exclusive to more routine interventions.
- Accumulated experience and modern technologies have reduced mortality and complication rates.
- The program demonstrates successful adaptation to organ donor limitations through living donor transplantation.