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Living donor LT provides better survival, lower costs vs. deceased donors

Living donor liver transplantation showed multiple superior outcomes compared with deceased donor liver transplantation, including longer survival and shorter lengths of hospital stay, according to a study published in Annals of Surgery.

Abhinav Humar, MD, and colleagues from the University of Pittsburgh, Pennsylvania, wrote that living donor liver transplant (LDLT) comprises more than half of all the liver transplants performed at their center. To compare LDLT and deceased liver donor transplant (DDLT), the researchers reviewed transplants performed by a single surgical team during a 10-year period.

“There have been now several single-center analyses, national data analysis, and multicenter analysis that have all demonstrated superior outcomes with LDLT vs. DDLT, especially beyond a certain learning curve for the center,” Humar and colleagues wrote. “Despite this, very few centers have embraced the procedure, and it continues to be utilized by only a few programs in often selected situations, mainly in patients with lower acuity of illness.”

The study comprised 245 LDLT cases and 592 DDLT cases performed between 2009 and 2019. Recipients of DDLT had higher MELD scores (P < .01), were more likely to have underlying hepatocellular cancer (36% vs. 22%; P < .01) and were more likely to be older (P < .01).

Patients who underwent LDLT had an overall 5% advantage over those who received DDLT. At 3 years posttransplant, patient survival was higher in the LDLT group compared with the DDLT group (86% vs. 80%; P = .03).

Recipients of LDLT also had a “smoother operative course” with a lower likelihood of needing intraoperative blood or blood products (52% vs. 78%; P = .01), a shorter length of hospital stay (median, 11 vs. 13 days; P = .03), and lower likelihood of needing early posttransplant dialysis (1.6% vs. 7.4%; P < .01).

Finally, the researchers performed a cost-effectiveness analysis including health care costs for 6 months before transplant, the procedure itself, and 1 year of posttransplant care. The overall cost associated with LDLT was 29.5% lower compared with DDLT related to fewer radiology scans, visits to the ER, less blood product used, and shorter hospital stays.

“Our feeling is that an LDLT should be considered the first and best option for most patients with liver disease and that patients should be offered the option of a LDLT if a suitable LD is available based on the ability of the procedure to provide a survival advantage to the patient over best other therapy available,” Humar and colleagues concluded. – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.