Outcomes for living donor, deceased donor liver transplantation comparable at experienced centers

BOSTON — When performed at experienced centers, outcomes for living donor liver transplantation are equivalent, and possibly superior, to deceased donor liver transplantation, researchers reported at The Liver Meeting.

“Over time, there has been enhanced appreciation of the technical aspects, perioperative management, and donor and recipient qualities for successful living donor liver transplantation,” David S. Goldberg, MD, from the division of gastroenterology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, said during a plenary presentation.

David S. Goldberg

Goldberg and colleagues evaluated national Organ Procurement and Transplantation Network/United Network for Organ Sharing data from 2002 to 2012 to ascertain whether living donor liver transplantation (LDLT) provides long-term survival outcomes compared with deceased donor liver transplantation (DDLT), and to develop a risk score based on donor-recipient characteristics to predict LDLT outcomes and optimize matching and counseling.

The study included 2,103 LDLTs and 46,674 DDLTs.

LDLT recipients had higher graft and patient survival compared with DDLT recipients (P<.001), but only among LDLTs at experienced centers that have performed at least 15 LDLTs. Graft survival of LDLTs was 75% in 2002 to 2004 and increased to 82% in 2008. Less graft failure was reported in LDLT recipients with autoimmune hepatitis (HR=0.56; 95% CI, 0.37-0.84) or cholestatic liver disease (HR=0.76; 95% CI, 0.63-0.92) who underwent transplantation at experienced centers; these subgroups also had increased patient survival.

“I would say that post-transplant outcomes of LDLT are as good as, if not better than, DDLT, especially when performed at an experienced center. Recently, American Association for the Study of Liver Diseases guidelines for transplantation suggested that LLDT is controversial. These data would suggest that the issue of LDLT, at least from the recipient side, is less controversial,” Goldberg said.

The LDLT risk-score index, which stratifies recipients as high, intermediate or low risk, predicted 3-year graft survival in more than 87% of the low-risk group to less than 74% in the high-risk group.

“This risk score, when validated in a separate cohort, which we are currently doing, may help to identify donor-recipient combinations to achieve the best [LDLT] outcomes,” Goldberg said. However, “this score is not yet ready to use for clinical purposes, and requires further validation.” – by Adam Leitenberger

For more information:

Goldberg DS. Abstract 3. Presented at: The Liver Meeting; Nov. 7-11, 2014; Boston.

Disclosure: Goldberg reports receiving grant/research report from Bayer Healthcare.