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Live-donor liver transplantation yielded better survival outcomes

Patients who underwent living-donor liver transplantation had similar, and sometimes better, post-transplant outcomes compared with recipients who underwent deceased-donor liver transplantation, according to results from a recent study.

“The deceased-donor organ supply in the United States has not been able to keep pace with the increasing demand for liver transplantation,” the researchers wrote. “It is unknown whether national [living-donor liver transplantation] outcomes have improved relative to [deceased-donor liver transplantation] and recent American Association for the Study of Liver Diseases guidelines refer to [living-donor liver transplantation] as ‘controversial.’” 

Researchers collected and analyzed data on 48,777 liver transplant recipients from the Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) database between 2002 and 2012. Of these, 2,103 had undergone living-donor liver transplantation (LDLT) and 46,674 had undergone deceased-donor liver transplantation (DDLT). Multivariate models were used to determine whether LDLT was a superior method of transplantation compared with DDLT. Additionally, researchers developed a new risk score using donor and recipient characteristics to perfect donor and recipient selection for LDLT.

Post-transplant survival and graft were higher in patients who underwent LDLT compared with DDLT patients (P<.001). Three-year graft survival for LDLT recipients was 78.9% compared with 75.5% of DDLT recipients. However, when LDLT recipients were adjusted depending on whether they were among the first 15 LDLT recipients at a center, the graft survival was not different among LDLT and DDLT recipients, but graft survival remained higher for the LDLT recipients that were not among the first 15 (P<.001).

According to the research, in unadjusted analyses, post-transplant graft survival was higher among LDLT patients who were not one of the first 15 patients at a center (P=.006), whereas patient survival was not different when compared with the DDLT recipients (P=.07).

Multivariate analysis showed that LDLT recipients had decreased risk for graft failure if they had autoimmune hepatitis (HR=0.56; 95% CI, 0.37-0.84) or cholestatic liver disease (HR=0.76; 95% CI, 0.63-0.92).

The LDLT risk score was able to predict certain graft survival rates after combining donor and recipient factors, indicating that it could be used to evaluate graft survival for a given recipient with five potential donors, according to the research.

“We demonstrate that in the current MELD era, LDLT is associated with significantly superior unadjusted patient and graft survival relative to DDLT,” the researchers concluded. “These data clearly demonstrate that the benefit of LDLT relative to DDLT extends to post-transplant outcomes and are not restricted to the benefits of earlier transplantation and its impact on decreasing waitlist mortality.”  

Disclosure: The researchers report no relevant financial disclosures.