Graft and patient survival after adult live donor liver transplantation compared to a matched cohort who received a deceased donor transplantation

Abstract

Live donor liver transplantation (LDLT) has become increasingly common in the United States and around the world. In this study, we compared the outcome of 764 patients who received LDLT in the United States and compared the results with a matched population that received deceased donor transplantation (DDLT) using the United Network for Organ Sharing (UNOS) database. For each LDLT recipient (n ‫؍‬ 764), two DDLT recipients (n ‫؍‬ 1,470), matched for age, gender, race, diagnosis, and year of transplantation, were selected from the UNOS data after excluding multiple organ transplantation or retransplantation, children, and those with incomplete data. Despite our matching, recipients of LDLT had more stable liver disease, as shown by fewer patients with UNOS status 1 or 2A, in an intensive care unit, or on life support. Creatinine and cold ischemia time were also lower in the LDLT group. Primary graft nonfunction, hyperacute rejection rates, and patient survival by Kaplan-Meier analysis were similar in both groups (2-year survival was 79.0% in LDLT vs. 80.7% in case-controls; P ‫؍‬ .5), but graft survival was significantly lower in LDLT (2-year graft survival was 64.4% vs. 73.3%; P < .001). Cox regression (after adjusting for confounding variables) analysis showed that LDLT recipients were 60% more likely to lose their graft compared to DDLT recipients (hazard ratio [HR] 1.6; confidence interval 1.1-2.5). Among hepatitis C virus (HCV) patients, LDLT recipients showed lower graft survival when compared to those who received DDLT. In conclusion, short-term patient survival in LDLT is similar to that in the DDLT group, but graft survival is significantly lower in LDLT recipients. LDLT is a reasonable option for patients who are unlikely to receive DDLT in a timely fashion. (Liver Transpl 2004; 10:1263-1268.)

Small‐for‐size grafts increase recurrence of hepatocellular carcinoma in liver transplantation beyond milan criteria

“…HBV infection was found in 89.3% (n 5 293) of recipients. The median Child-Pugh score was 6 (interquartile range [IQR], [4][5][6][7][8], and the median MELD score was 11 (IQR, 9-16). With regard to T stage, T2 was the most common, observed in 58.2% (n 5 191) of the patients, followed by T1 in 23.5% (n 5 77) of the patients.…”

“…Shear stress caused by transient portal hypertension can cause acute mechanical injury, which then induces severe inflammatory responses to negatively affect the outcomes of liver transplantation (LT). (4)(5)(6) Reports showed that SFSG causes graft dysfunction following LT and adversely affects graft survival despite rapid hepatic regeneration. (4)(5)(6) Moreover, studies have reported an association between SFSG and high tumor recurrence rates following LT for hepatocellular carcinoma (HCC).…”

“…(4)(5)(6) Reports showed that SFSG causes graft dysfunction following LT and adversely affects graft survival despite rapid hepatic regeneration. (4)(5)(6) Moreover, studies have reported an association between SFSG and high tumor recurrence rates following LT for hepatocellular carcinoma (HCC). They indicated that the tumor recurrence rate increased more significantly following LDLT using partial liver grafts for HCC than deceased donor liver transplantation (DDLT) based on retrospective clinical data.…”

Impact of donor age on survival and fibrosis progression in patients with hepatitis C undergoing liver transplantation using HCV+ allografts

“…3 Innovative ways of expanding the donor pool are the use of split and live donor liver transplantation as well as the use of liver allografts containing appreciable steatosis or with past exposure to hepatitis B. [4][5][6] The use of HCV-positive (HCVϩ) allografts/grafts in HCV patients is another such strategy and has now become routine at most transplant centers.…”

HCV: Alive and kicking in living donor liver grafts?

“…[4][5][6] Similarly, the presence of significant steatosis in the graft and a long cold ischemia time are also associated with a poor outcome of HCV infection after LT. 3 Recently, several reports have suggested that recurrence of HCV infection is more severe in patients undergoing living donor liver transplantation (LDLT) compared to deceased donor liver transplantation (DDLT). 1,7 This observation is still highly controversial, as data from other studies have found similar patient and graft survival rates in both groups of patients. 8,9 The topic is extremely relevant, as LDLT has become an important strategy to expand the organ donor pool.…”