Comparative Analysis of Outcomes in Living and Deceased Donor Liver Transplants for Primary Sclerosing Cholangitis

Abstract

Introduction Primary sclerosing cholangitits (PSC) is a progressive fibrosing cholangiopathy eventually leading to endstage liver disease (ESLD). While literature for deceased donor liver transplantation (DDLT) for PSC abounds, only a few reports describe live donor liver transplant (LDLT) in the setting of PSC. We present a single-center experience on survival outcomes and disease recurrence for LDLT and DDLT for ESLD secondary to PSC. Aim The aim of this study was to analyze survival outcomes and disease recurrence for LDLT and DDLT for ESLD secondary to PSC. Patients and Methods A retrospective review of 58 primary liver transplants for PSC-associated ESLD, performed between May 1995 and January 2007, was done. Patients were divided into two groups based on donor status. Group 1 (n=14) patients received grafts from living donors, while group 2 (n=44) patients received grafts from deceased donors. An analysis of survival outcomes and disease recurrence was performed. Recurrence was confirmed based on radiological and histological criteria. Results Recurrence of PSC was observed in four patients in LDLT group and seven in DDLT group. Retransplantation was required in one patient in LDLT group and nine patients in DDLT group. One patient (7%) among LDLT and six patients (14%) among DDLT died. The difference in patient and graft survival was not statistically significant between the two groups (patient survival, p=0.60; graft survival, p=0.24). Conclusion This study demonstrates equivalent survival outcomes between LDLT and DDLT for PSC; however, the rate of recurrence may be higher in patients undergoing LDLT.

Living Donor and Deceased Donor Liver Transplantation for Autoimmune and Cholestatic Liver Diseases—An Analysis of the UNOS Database

“…This study confirms the findings of our previous study that superior graft quality as well as the favorable elective timing of LDLT conferred better patient and graft survival. 29 Also from this study, it appears that there has been an overall improvement in the 5-year survival for autoimmune and cholestatic diseases; however, it would be interesting to see the long-term outcome of these patients. …”

Outcomes of Patients with Benign Liver Diseases Undergoing Living Donor versus Deceased Donor Liver Transplantation

“…However, the graft survival rate was significantly lower in patients undergoing LDLT. Kashyap et al [44] reported a higher recurrence rate of primary sclerosing cholangitis in patients undergoing LDLT. This difference may be due to the difference of aetiology of the disease.…”

Survival Without Biliary Complications After Liver Transplant for Primary Sclerosing Cholangitis

“…42 Living-related liver transplant may be associated with an increased risk of developing recurrent primary sclerosing cholangitis, in support of the hypothesis that human leukocyte antigen mismatching may have a positive effect on disease recurrence. 43,44 Although living donor transplant may have advantages in timing and neoadjuvant protocols in patients who have cholangiocellular carcinoma, there may be an increased risk for developing recurrent primary sclerosing cholangitis. In contrast, mismatching may be associated with increased risk of graft rejection and allograft dysfunction, especially in patients who have liver transplant for other liver diseases, and this may outweigh the positive effects of mismatching on autoimmune mechanisms.…”