Liver transplant recipients gain up to 17 life-years from living donors vs. donor waitlist
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A case-control study in JAMA Surgery revealed that patients with end-stage liver disease had a 34% reduction in mortality after living-donor liver transplantation compared with patients who remained on a wait list for a deceased donor.
Researchers wrote that the survival benefit of living-donor liver transplantation (LDLT), especially in patients with low MELD incorporating sodium levels (MELD-Na) scores, is “remarkable,” as previously published studies with deceased donors noted that such benefits occurred in patients with scores of 15 or higher.
“This study’s findings definitively demonstrate the association of a marked benefit in
survival and life-years with receipt of an LDLT,” Whitney E. Jackson, MD, assistant professor of gastroenterology and medical director of living donor liver transplantation at University of Colorado School of Medicine, and colleagues wrote. “This association challenges the current paradigm of the timing of referral for a liver transplant and may have ramifications for allocation policies for deceased donors. These data also serve to inform potential donors of the benefit to their recipient to contextualize risk-benefit discussions.”
Using data from the Scientific Registry of Transplant Recipients from Jan. 1, 2012, to Sept. 2, 2021, Jackson and colleagues retrospectively analyzed 119,275 adult LT candidates, of whom 2,820 received an LDLT and 116,455 were assigned to the waitlist. The goal of the study was to determine the survival benefit, number of life-years saved and MELD-Na score at which survival benefit was achieved for those who underwent LDLT compared with those who remained on the waitlist.
According to the study, the mean age of participants was 55.1 years, 63% were men and 70.2% were white. In addition, patients in the LDLT group were younger, more educated and more likely to be female and white compared with patients who remained on the waitlist. One-third of waitlisted patients had a MELD-Na score of at least 14 when placed on the list.
Using mortality risk and survival models, investigators found that LDLT was linked with a significant survival benefit in patients with a MELD-Na score as low as 11, “with a 34% decrease in mortality compared with that for patients on the waitlist.” Further, patients in the LDLT group gained an additional 13 to 17 life-years compared with waitlisted patients.
“Our results suggest that, for patients with MELD-Na scores higher than 11, nationwide acceptance of an LDLT as a superior alternative to waiting for a deceased donor will significantly increase survival compared with remaining on the waitlist,” the authors wrote.
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