Clinical Impacts of Donor Types of Living vs. Deceased Donors: Predictors of One-Year Mortality in Patients with Liver Transplantation

Abstract

Transplantation studies about the clinical differences according to the type of donors are mostly conducted in western countries with rare reports from Asians. The aims of this study were to evaluate the clinical impacts of the type of donor, and the predictors of 1-year mortality in patients who underwent liver transplantation (LT). This study was performed for liver transplant recipients between May 2010 and December 2014 at the Pusan National University Yangsan Hospital. A total of 185 recipients who underwent LT were analyzed. Of the 185 recipients, 109 (58.9%) belonged to the living donor liver transplantation (LDLT) group. The median age was 52.4 years. LDLT recipients had lower model for end-stage liver disease (MELD) score compared with better liver function than deceased donor liver transplantation (DDLT) recipients (mean ± standard deviation [SD], 12.5 ± 8.3 vs. 24.9 ± 11.7, respectively; P < 0.001), and had more advanced hepatocellular carcinoma (HCC) (62.4% vs. 21.1%, respectively; P = 0.001). In complications and clinical outcomes, LDLT recipients showed shorter stay in intensive care unit (ICU) (mean ± SD, 10.8 ± 8.8 vs. 23.0 ± 13.8 days, respectively, P < 0.001), ventilator care days, and post-operative admission days, and lower 1-year mortality (11% vs. 27.6%, respectively, P = 0.004). Bleeding and infectious complications were less in LDLT recipients. Recipients with DDLT (P = 0.004) showed higher mortality in univariate analysis, and multi-logistic regression analysis found higher MELD score and higher pre-operative serum brain natriuretic peptide (BNP) were associated with 1-year mortality. This study may guide improved management before and after LT from donor selection to post-operation follow up.

Cystic duct anastomosis can be a viable option for biliary reconstruction in case of multiple ducts in right lobe living-donor liver transplantation

“…Higher donor age correlated with increased overall biliary morbidity in our recipients, similar to findings of the Turkish group [20]. The one-year survival of the CD group and that of the overall cohort were similar to results of survival reported in literature (86.8%, 88.7%, and 89.0%, respectively) [21].…”

Increased Surgical Complications but Improved Overall Survival with Adult Living Donor Compared to Deceased Donor Liver Transplantation: A Systematic Review and Meta-Analysis

“…Fourteen studies [ 10 , 11 , 13 , 14 , 17 , 19 , 23 , 31 , 34 , 36 , 38 , 40 , 42 , 45 ] reported the biliary complication rate. Four studies [ 10 , 13 , 17 , 38 ] showed no significant difference between LDLT and DDLT, while the rest of the studies [ 11 , 14 , 19 , 23 , 31 , 34 , 36 , 40 , 42 , 45 ] indicated a significantly higher biliary complication rate in LDLT. Significant heterogeneity existed ( P < 0.00001, I 2 = 77%).…”

“…Eighteen studies [ 4 , 11 , 13 – 16 , 21 , 24 – 28 , 34 , 35 , 39 , 41 , 44 , 47 ] reported 1-year OS. Four of them [ 13 , 14 , 16 , 28 ] suggested a significantly higher 1-year OS in LDLT, and the rest [ 4 , 11 , 15 , 21 , 24 – 27 , 34 , 35 , 39 , 41 , 44 , 47 ] showed no significant difference between LDLT and DDLT. A random-effect model revealed a significantly higher 1-year OS in LDLT (OR = 1.32, 95%CI = 1.01 to 1.72, P = 0.04; Figure 15 ).…”

“…Eighteen studies[4, 11, 13-16, 21, 24-28, 34, 35, 39, 41, 44, 47] reported 1-year OS. Four of them[13,14, 16,28] Figure6: Meta-analysis of studies comparing perioperative mortality between LDLT and DDLT recipients based on a fixed-effect model.…”