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Clinical outcomes of liver transplantation for polycystic liver disease: A single center experience
Natasha Chandok
,
Corresponding author
chandok.n@gmail.com

Correspondence and reprint request: Natasha Chandok, MD, Multi-Organ Transplant Program, Division of Gastroenterology, University of Western Ontario, 339 Windermere Road. London, Ontario. N6A 5A5 Canada, Tel.: 519-685-8500 x 34882. Fax: 519-663-3858
, Julia Uhanova**, Paul Marotta*
* Division of Gastroenterology, Multi-Organ Transplant Program, London Health Sciences Center, University of Western Ontario.
** Section of Hepatology, John Buhler Research Center, University of Manitoba.
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Polycystic liver disease &#40;PLD&#41; is a celiopathy caused by defects in polycystin proteins&#46; The autosomal dominant &#40;AD&#41; form of the disease is characterized by the development of multiple simple cysts in the liver that progress in size over time&#46; Although an autosomal recessive &#40;AR&#41; form of PLD exists&#44; this condition is rare and is associated with autosomal recessive polycystic kidney disease &#40;ARPCKD&#41;&#44; congenital hepatic fibrosis&#44; intrahepatic biliary dilatation and a high mortality in infancy&#46; As such&#44; in adulthood only AD PLD is seen&#46; Autopsy series suggest that the prevalence of PLD is 0&#46;13&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">When PLD occurs in association with autosomal dominant polycystic kidney disease &#40;ADPCKD&#41;&#44; the pathogenesis involves defects of polycystin-1 or&#44; less commonly&#44; polycystin-2&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In contrast&#44; when AD PLD has no concurrent renal involvement&#44; mutations of the gene protein kinase substrate 80K-H &#40;PR-KCSH&#41;&#44; which encodes the protein hepatocystin&#44; are implicated&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Polycystin proteins are integral to the function of cilia lining cholangiocytes&#46; In the setting of defective cystoproteins in cilia&#44; cyst formation occurs through a variety of mechanisms&#44; including enhanced cell proliferation and apoptosis&#59; increased secretion of fluid&#59; and faulty cell adhesion and ciliary function&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Estrogens and a variety of growth factors also play a role in cyst proliferation and secretion&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="p0015" class="elsevierStylePara elsevierViewall">PLD has a broad spectrum of clinical manifestations&#46; Clinically&#44; PLD is defined as 5 or more simple cysts greater than I cm in diameter&#44; in the absence of infection or trauma&#46; Interestingly&#44; patients with more severe liver involvement from PLD may be predisposed to more significant renal dysfunction from ADPCKD&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Conversely&#44; patients with more extensive renal cystic disease develop more liver cysts&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> PLD is more severe in women&#44; likely because of the hypothesized role played by female sex hormones in the pathogenesis of liver cyst formation&#46;</p><p id="p0020" class="elsevierStylePara elsevierViewall">While liver failure is uncommon from PLD&#44; and most patients require no radiologic or surgical intervention&#44; in a minority of patients liver cysts cause significant morbidity&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Compressive symptoms produced by hepatic cysts can result in gastrointestinal obstruction&#44; hepatic venous outflow obstruction&#44; and compression of the inferior vena cava&#44; portal vein and bile ducts&#46; Other cyst complications include hemorrhage&#44; infection&#44; torsion or rupture&#46;</p><p id="p0025" class="elsevierStylePara elsevierViewall">Although there are no proven medical treatments for PLD&#44; surgical techniques involving hepatic volume reduction are the cornerstone of care for the rare patient with severe symptoms due to innumerable large cysts unsuitable for cyst aspiration and sclerosis&#46; Operative techniques include partial hepa-tectomy with remnant cyst fenestration&#44; cyst fenes-tration alone&#44; or LT&#46; While there are no strict criteria for LT for PLD&#44; generally transplantation is reserved for patients with significant morbidity from severe cystic disease refractory to other radiologic and surgical techniques&#46; Such patients typically have no intrinsic liver dysfunction but have a poor quality of life due to symptoms such as dyspnea&#44; early satiety&#44; and abdominal and back pain&#46; Many liver transplantation allocation systems &#40;e&#46;g&#46; United Network for Organ Sharing&#59; Trillium Gift of Life Network Ontario&#41; provide exception points for listing patients with PLD following careful consideration by a multidisciplinary committee on a case-by-case basis&#46;</p><p id="p0030" class="elsevierStylePara elsevierViewall">As PLD is an uncommon albeit established indication for LT&#44; there is limited information on immediate post-operative as well as long-term clinical outcomes&#46; In a German series of 36 subjects&#44; Kirch-ner et al reported that recipients transplanted for PLD reported an improved quality of life and had excellent long-term survival&#44; although 5 &#40;13&#46;9&#37;&#41; subjects died of medical complications within 2 months of transplantation&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Similarly&#44; in amongst largest series published in North America to date of 13 subjects transplanted for PLD&#44; Taner&#44; <span class="elsevierStyleItalic">et &#945;l&#46;&#44;</span> reported 3 deaths in the postoperative period&#44; and 9 post-transplant surgical procedures for 5 patients due to surgical complications &#40;bowel perforation&#44; bile leak&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> If patients survived the post-surgical period&#44; however&#44; excellent long-term patient and graft survivals were seen&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="p0035" class="elsevierStylePara elsevierViewall">One may postulate that patients with PLD may have a complex operative course due to the challenges in resecting a massive native liver with distortion of vascular structures&#46; Moreover&#44; given the strong correlation of ADPCKD&#44; it is conceivable that patients transplanted for PLD may experience higher rates of renal failure over time&#46; Further data are needed to explore these hypotheses and corroborate with the findings of prior studies&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Aim</span><p id="p0040" class="elsevierStylePara elsevierViewall">The purpose of this study is to describe the postoperative and long-term clinical outcomes of all patients transplanted for PLD at a Canadian transplant center&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Methods</span><p id="p0045" class="elsevierStylePara elsevierViewall">A retrospective cohort study was conducted on all adult patients transplanted for PLD from January 1993 to February 2010 at London Health Sciences Center&#44; London&#44; Canada&#46; All subjects provided consent&#44; and approval was obtained by the institutional ethics committee&#46; Patients were identified through the institutional liver transplant database&#46; Using hospital health records&#44; information was gathered on patient demographics &#40;date of birth&#44; race&#44; sex&#44; medical comorbidities&#41;&#44; baseline liver and kidney function&#44; date of LT&#44; type of LT &#40;deceased&#44; deceased after cardiac death&#44; or live donor&#41;&#44; size and length of explanted liver&#44; postoperative surgical and medical complications&#44; re-operation &#40;including re-transplantation&#41;&#44; length of hospitali-zation&#44; and re-admission within 3 months&#46; Patient charts were also examined to document long-term medical complications&#44; namely new onset renal failure &#40;defined as need for hemodialysis or kidney transplantation&#41;&#46; All subjected were contacted in April 2010 to verify their survival and their need&#44; if any&#44; for long-term hemodialysis or kidney transplantation&#46; Descriptive statistics were reported as frequencies&#44; means and ranges&#46; Statistical analysis was performed using STATA 11&#46;0&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Results</span><p id="p0050" class="elsevierStylePara elsevierViewall">From January 1993 to February 2010&#44; 14 patients underwent LT and 1 patient underwent combined kidney and LT for polycystic disease&#46; Baseline characteristics are summarized in <a class="elsevierStyleCrossRef" href="#t0005">table 1</a>&#46; All subjects were female&#44; with mean age 49&#46;0 &#40;40&#46;0-65&#46;0&#41; at the time of LT&#46; No subjects underwent prior cyst fenestration and&#47;or partial hepatectomy&#46; All recipients received deceased grafts&#46; 14 &#40;93&#46;37&#41; subjects were Caucasian and 1 &#40;6&#46;7&#37;&#41; subject was Asian&#46; 10 &#40;66&#46;7&#37;&#41; patients had concomitant ADPCKD&#46; The mean creatinine just prior to LT was 112&#46;9 umol&#47;L &#40;43-209&#41;&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><p id="p0055" class="elsevierStylePara elsevierViewall">The weight and length of the native liver following resection are summarized in <a class="elsevierStyleCrossRef" href="#t0010">table 2</a>&#46; The mean weight of the explanted liver was 6830&#46;7 g &#40;2770&#46;09119&#46;0&#41;&#46; The mean diameter of the explanted liver was 34&#46;4 cm &#40;22&#46;0-45&#46;0&#41;&#46;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><p id="p0060" class="elsevierStylePara elsevierViewall">Postoperative complications are shown in <a class="elsevierStyleCrossRef" href="#t0015">table 3</a>&#46; Overall&#44; 5 of 15 subjects had vascular complications&#44; including 3 &#40;20&#37;&#41; and 2 &#40;13&#46;3&#37;&#41; subjects with hepatic artery thrombosis &#40;HAT&#41; and hepatic artery stenosis &#40;HAS&#41;&#44; respectively&#46; No patients had portal vein thombosis &#40;PVT&#41; or bile leak&#46; One &#40;6&#46;7&#37;&#41; patient had significant wound complications&#46; Overall&#44; 3 &#40;20&#37;&#41; patients needed to return to the operating theatre for management of HAT&#46; One subject required re-transplantation due to early graft loss from HAT at day 3 post-transplantation&#46; The mean length of hospitalization was 18&#46;8 &#40;7-49&#41; days&#46; Postoperative medical complications were not observed at an increased frequency&#44; and no patients were re-admitted to the hospital within 3 months of discharge&#46;</p><elsevierMultimedia ident="t0015"></elsevierMultimedia><p id="p0065" class="elsevierStylePara elsevierViewall">All patients received long-term follow-up care&#46; The mean follow-up was 66&#46;7 months &#40;3-200&#41;&#46; The I and 5-year patient survival was 100&#37;&#46; The I and 5-year graft survival was 93&#46;3&#37;&#46; One subject died 8 years after LT at the age of 57 due to trauma&#59; and a second subject died 7 years after LT at the age of 67 due to natural causes&#44; though no autopsy report was available&#46; Thirteen subjects were contacted directly in April 2010 and their survival was verified&#46; No patient&#44; including those who have deceased&#44; developed renal failure necessitating hemodialysis or kidney transplantation&#44; or chronic hepatic allograft dysfunction warranting liver re-transplantation&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="p0070" class="elsevierStylePara elsevierViewall">In this series of 15 subjects transplanted for PLD&#44; 1 patient experienced early graft loss due to HAT&#44; but all subjects had excellent long-term survival&#46; The 1-year and 5-year patient and graft survival was 100&#37; and 93&#46;3&#37;&#44; and 100&#37; and 93&#46;3&#37;&#44; respectively&#46; This compares favorably to our center&#8217;s overall 1-year patient and graft survival of 91&#37; and 88&#37;&#44; and 5-year patient and graft survival of 86&#37; and 81&#37;&#44; respectively&#44; from 1999 to 2008 &#40;n &#61; 619&#44; unpublished data&#41;&#46;</p><p id="p0075" class="elsevierStylePara elsevierViewall">However&#44; subjects experienced a higher than expected rate of HAT at 20&#37; and HAS at 13&#46;3&#37;&#59; this compares unfavorably to our center&#8217;s overall rate of HAT of 5&#37; from 1999-2008 &#40;unpublished data&#41;&#46; Given the retrospective nature of this study&#44; a detailed analysis into the possible etiology of HAT was not feasible&#46; Nevertheless&#44; we postulate that because patients with PLD do not have an intrinsic coagulopa-thy like patients with hepatic dysfunction&#44; perhaps the clamping of the hepatic artery during the transplantation may predispose to thrombosis&#46; Furthermore&#44; given the excess space in the abdominal cavity following resection of the native liver&#44; there is a theoretical risk of torsion or volvulus of the hepatic graft&#44; compromising hepatic artery blood flow&#46; To minimize operative complications&#44; in patients with extensive cysts incorporating the cava&#44; caval interposition with veno-venous bypass may be preferred to the piggyback technique&#46;</p><p id="p0080" class="elsevierStylePara elsevierViewall">Post-operative medical complications were not observed at an increased frequency&#46; Subjects had a mean of 18&#46;8 days in hospital&#46; This length of hospi-talization is significantly longer than our mean length of stay of 8&#46;5 days following an uncomplicated LT from 1999 to 2008 &#40;unpublished data&#41;&#46; The longer hospitalization was observed in subjects with postoperative vascular complications requiring surgical repair&#46;</p><p id="p0085" class="elsevierStylePara elsevierViewall">None of the subjects had significant long-term renal impairment requiring hemodialysis or kidney transplantation&#44; despite the fact that 2-thirds of the subjects had concomitant ADPCKD&#46; We hypothesize that a possible reason for low rates of severe renal injury is our common practice to continue mycofeno-late mofitil and&#47;or low dose prednisone long-term&#44; and minimize calcineurine inhibitors in recipients at higher risk for renal injury&#46;</p><p id="p0090" class="elsevierStylePara elsevierViewall">A strength of this study is that we report on a well-sized cohort of subjects who underwent LT for a relatively rare indication&#46; Furthermore&#44; all subjects received long-term follow up&#44; thereby enabling accuracy in the reporting of clinical outcomes such as patient and graft survival&#44; and the development of severe renal disease&#46; A limitation of the study is that that the small sample size precludes multivaria-te analysis&#46;</p><p id="p0095" class="elsevierStylePara elsevierViewall">A multicenter study to examine postoperative clinical outcomes following LT for PLD is needed to verify the findings of this study&#44; especially the higher rate of HAT&#46; In conclusion&#44; despite increased rates of post-operative vascular complications in patients transplanted for PLD&#44; high rates of patient and graft survival are seen&#46; Furthermore&#44; renal failure is not observed at an increased frequency&#44; even among patients with co-existent PCKD&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Abbreviations</span><p id="p0100" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="li0005"><li class="elsevierStyleListItem" id="list0005"><span class="elsevierStyleLabel">&#8226;</span><p id="p0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">AD&#58;</span> Autosomal dominant&#46;</p></li><li class="elsevierStyleListItem" id="list0010"><span class="elsevierStyleLabel">&#8226;</span><p id="p0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">ADPCKD&#58;</span> Autosomal dominant polycystic kidney disease&#46;</p></li><li class="elsevierStyleListItem" id="list0015"><span class="elsevierStyleLabel">&#8226;</span><p id="p0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">CI&#58;</span> Calcineurin inhibitor&#46;</p></li><li class="elsevierStyleListItem" id="list0020"><span class="elsevierStyleLabel">&#8226;</span><p id="p0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">DDLT&#58;</span> Deceased donor liver transplantation&#46;</p></li><li class="elsevierStyleListItem" id="list0025"><span class="elsevierStyleLabel">&#8226;</span><p id="p0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HAS&#58;</span> Hepatic artery stenosis&#46;</p></li><li class="elsevierStyleListItem" id="list0030"><span class="elsevierStyleLabel">&#8226;</span><p id="p0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HAT&#58;</span> Hepatic artery thrombosis&#46;</p></li><li class="elsevierStyleListItem" id="list0035"><span class="elsevierStyleLabel">&#8226;</span><p id="p0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">LDLT&#58;</span> Live donor liver transplantation&#46;</p></li><li class="elsevierStyleListItem" id="list0040"><span class="elsevierStyleLabel">&#8226;</span><p id="p0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">LT&#58;</span> Liver transplantation&#46;</p></li><li class="elsevierStyleListItem" id="list0045"><span class="elsevierStyleLabel">&#8226;</span><p id="p0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">PCKD&#58;</span> Polycystic kidney disease&#46;</p></li><li class="elsevierStyleListItem" id="list0050"><span class="elsevierStyleLabel">&#8226;</span><p id="p0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">PLD&#58;</span> Polycystic liver disease&#46;</p></li><li class="elsevierStyleListItem" id="list0055"><span class="elsevierStyleLabel">&#8226;</span><p id="p0155" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">PVT&#58;</span> Portal vein thrombosis&#46;</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Financial Disclosures</span><p id="p0160" class="elsevierStylePara elsevierViewall">None for all authors&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Acknowledgment</span><p id="p0165" class="elsevierStylePara elsevierViewall">The authors thank Dr&#46; Mamoun Al-Basheer&#44; Dr&#46; William Wall&#44; Mr&#46; Paul Myers and Mr&#46; Michael Blo-ch for their assistance in the preparation of the manuscript&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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          "identificador" => "xres1211009"
          "titulo" => "Abstract"
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        1 => array:2 [
          "identificador" => "xpalclavsec1127293"
          "titulo" => "Key words"
        ]
        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        3 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Aim"
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        4 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Methods"
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        5 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Results"
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        6 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Discussion"
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        7 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Abbreviations"
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          "identificador" => "sec0035"
          "titulo" => "Financial Disclosures"
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        9 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Acknowledgment"
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          "titulo" => "References"
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      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2010-05-24"
    "fechaAceptado" => "2010-06-28"
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          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "Polycystic liver disease"
            1 => "Autosomal dominant"
            2 => "Liver transplantation"
            3 => "Survival"
            4 => "Postoperative complications"
            5 => "Hepatic artery thrombosis"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abs0005" class="elsevierStyleSection elsevierViewall"><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Polycystic liver disease &#40;PLD&#41; is a celiopathy characterized by progressive growth of multiple hepatic cysts&#46; In a minority of patients&#44; severe symptomatic hepatomegaly necessitates liver transplantation &#40;LT&#41;&#46; The purpose of this study is to describe the postoperative and long-term outcomes of all patients transplanted for PLD at our center&#46;</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">All patients who underwent LT for PLD were identified through our database&#46; Using patient charts&#44; data were extracted on patient demographics and medical history&#44; postoperative surgical and medical complications&#44; length of hospitalization&#44; prevalence of chronic kidney failure&#44; and patient and graft survival&#46; Subjects were contacted in April 2010 to verify their survival and confirm their need&#44; if any&#44; for hemodialysis and&#47;or kidney transplantation&#46; Descriptive statistics for patient and graft survival were performed&#46; From 1993 to 2010&#44; 14 subjects underwent LT and 1 subject underwent combined kidney and LT&#59; all subjects were female and the mean age was 49&#46;0 years&#46; 10 &#40;66&#46;7&#37;&#41; subjects had polycystic kidney disease&#46; Patients experienced a high rate of vascular complications&#44; including hepatic artery thrombosis &#40;HAT&#41; or stenosis in 3 &#40;20&#37;&#41; and 2 &#40;13&#46;3&#37;&#41; subjects&#44; respectively&#46; One subject had early graft loss due to HAT and underwent re-transplantation&#46; The mean length of hospitalization was 18&#46;8 days&#46; After a mean of 66&#46;8 months of follow-up &#40;3-200&#41;&#44; 13 &#40;86&#46;7&#37;&#41; subjects are alive with satisfactory graft function&#44; and no patients had renal failure&#46;</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">In conclusion&#44; patients who underwent LT for PLD had a high rate of postoperative vascular complications&#46; However&#44; long-term patient and graft survival&#44; and kidney function&#44; is excellent&#46;</p></span>"
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                  \t\t\t\t  " align="center" valign="middle" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="middle" scope="col" style="border-bottom: 2px solid black">Frequency n&#61;15&#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="middle">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">&#8226; Race&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="middle">White&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">14 &#40;93&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">Asian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">1 &#40;6&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">&#8226; Genetics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">Isolated ADPLD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">5 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">Associated ADPCKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">10 &#40;67&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">&#8226; Combined liver&#47;kidney transplant&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">1 &#40;6&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="middle">&#8226; Prior kidney transplant&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="middle">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="middle">&#8226; Renal insufficiency prior to liver transplant&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">2 &#40;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="middle" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="middle" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="middle" scope="col" style="border-bottom: 2px solid black">Range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">Explant weight &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">6830&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">2770&#46;0-9119&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">34&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">22&#46;0-45&#46;0&nbsp;\t\t\t\t\t\t\n
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">3 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">1 &#40;6&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">HAT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">3 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">HAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">2 &#40;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">Bile leak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="middle">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
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Article information
ISSN: 16652681
Original language: English
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es en pt

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