No outcome differences between patients undergoing living donor, deceased donor liver transplant

BOSTON — Patients with acute liver failure who underwent liver transplant with a living donor had similar outcomes to patients who received a liver from a deceased donor in a study presented at The Liver Meeting.

Researchers compared the clinical outcomes of patients with acute hepatic necrosis who received liver transplants between 1987 and 2010, including 90 who received living-donor transplantation (LDLT) and 4,881 who underwent deceased-donor transplantation (DDLT). Subgroup analysis of patients with status 1, 1A or 1B also was performed, including 21 LDLT patients and 2,204 DDLT recipients.

LDLT patients had significantly lower creatinine (median 0.9 mg/dL compared with 1.1 mg/dL) and total bilirubin levels (median 2.7 mg/dL compared with 11.7 mg/dL), as well as lower MELD scores (median 14 vs. 30) and international normalized ratio (INR) values (median 1.4 compared with 2.2) than participants who underwent DDLT (P<.0001 for all). Patients in the LDLT cohort also were on dialysis less frequently than DDLT patients (8% vs. 11%, P<.0097). Investigators noted that those receiving LDLT had a longer waiting time for transplant than DDLT patients (median 89 days compared with 5, P<.0001).

Subgroup analysis of status 1 patients indicated no significant differences between those receiving LDLT and those who underwent DDLT in creatinine levels (median 1.3 mg/dL vs. 1.3 mg/dL), bilirubin levels (median 19.9 mg/dL vs. 18.8 mg/dL), MELD score (median 35 vs. 37) or INR (median 2.9 vs. 3.3). Wait time for transplant was similar between groups (median 2 days for both).

Graft survival at 1 year after transplant was 75% in the DDLT and LDLT groups. Patient survival probabilities were 79% at 1 year and 71% at 5 years among DDLT recipients and 71% at 1 and 5 years for LDLT patients.

“One of the main controversies of LDLT is that patient and graft survival are not the same, but we demonstrated that they are very similar [to DDLT], and that living-donor transplantation is an option in those cases of acute liver failure that are at really high risk of mortality,” researcher Nathalie H. Urrunaga, MD, a fellow at the gastroenterology and hepatology division of the University of Maryland School of Medicine in Baltimore, told Healio.com.

For more information:

Urrunaga NH. P300: Similar Outcomes for Living Donor versus Deceased Donor Liver Transplantation for Acute Liver Failure in the United States. Presented at: The Liver Meeting 2012; Nov. 9-13, Boston.