Clin Transplant Res.  2024 Jun;38(2):116-127. 10.4285/ctr.24.0013.

Implementation of a living donor liver transplantation program in the Republic of Uzbekistan: a report of the first 40 cases

• Semash K
• Dzhanbekov T
• Akbarov M
• Mirolimov M
• Usmonov A
• Razzokov N
• Primov Z
• Gaybullaev T
• Yigitaliev S

• KMID: 2557605
• DOI: http://doi.org/10.4285/ctr.24.0013

Abstract

Background
Living donor liver transplantation (LDLT) is an effective treatment for patients with end-stage liver disease. This study was performed to evaluate the outcomes of the initial series of LDLT procedures performed in the Republic of Uzbekistan and to demonstrate that liver transplantation is viable under the conditions in this country.
Methods
Between October 2021 and December 2023, we performed 40 LDLTs. We evaluated both immediate and long-term outcomes.
Results
Thrombosis of the hepatic artery developed in one case (2.5%). Arterial anastomotic stenoses were diagnosed in three cases (7.5%) and were successfully treated with endovascular balloon vasodilation. Splenic artery steal syndrome arose in three patients (7.5%) and was managed with endovascular embolization of the splenic artery. One patient (2.5%) developed portal vein thrombosis. Portal vein stenosis occurred in two patients (5%) at 10 months posttransplantation and was addressed with endovascular balloon angioplasty, yielding good clinical outcomes. Biliary complications were observed in 45% of the cases, with bile leakages accounting for 89% of these issues and strictures of the biliary anastomoses for 11%. The in-hospital mortality rate was 12.5%.
Conclusions
Our research findings and analysis of complications align with the international literature, and the results are deemed acceptable during this implementation phase of the liver transplantation program. Accordingly, liver transplantation is feasible in the Republic of Uzbekistan; however, improvements in surgical and therapeutic methods are necessary to minimize the development of both early and late postoperative complications.

Keyword

Liver transplantation; Living donors; End-stage liver disease

Figure

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  Fig. 1 Vein outflow reconstruction techniques. (A) Venoplasty using donor falciform ligament. (B) Venoplasty using a polytetrafluoroethylene graft.

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  Fig. 2 Biliary reconstruction techniques. (A) Duct-to-duct anastomosis. (B) Anastomosis of a single duct with a Roux-en-Y loop. (C) Anastomosis of unified bile ducts with a Roux-en-Y loop. (D) Separate anastomoses of two bile ducts with a Roux-en-Y loop. (E) Three bile ducts opening onto the graft, with unification plasty of two ducts and two separate anastomoses of bile ducts with a Roux-en-Y loop. (F) Anastomosis of the main duct with a Roux-en-Y loop and duct-to-duct anastomosis with an aberrant bile duct in the right lobe.

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  Fig. 3 Survival probability for liver transplant recipients over a 26-month follow-up period.

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