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Liver transplant update: 6 reports on living vs. deceased donor outcomes

Recent studies have shown significant differences in patient survival and complications after liver transplantation with either a living donor or deceased donor organ. Additionally, awareness about living donor transplantation and the safety records for donors remains low among both physicians and the public.

Healio Gastroenterology and Liver Disease presents the following reports on living donor LT survival including costs compared with deceased donors, improved mortality outcomes with older donor livers, increasing rates of deceased donor organs with viral hepatitis, and a novel preservation technique that improved 5-year graft survival.

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 donor liver transplant (DDLT), the researchers reviewed transplants performed by a single surgical team during a 10-year period. Read more

O lder donor livers still discarded despite improving mortality outcomes

Between 2003 and 2016, liver graft loss and mortality rates among recipients of grafts from older donors improved; however, discard rates of older donor grafts continued to increase and use of older donor grafts decreased, according to a study published in JAMA Surgery.

“Our findings of improved posttransplant mortality and all-cause graft loss may be associated with several factors, including patient care, surgical technique, or improved donor to recipient matching,” Christine E. Haugen, MD, from the Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues wrote. “Exclusion of a potential organ donor should not be based on age alone, but donor age should be evaluated with donor to recipient matching and consideration of potential cold ischemia time.” Read more

Living liver-donor transplant awareness low, even among physicians

A survey released by WebMD and the University of Pittsburgh Medical Center revealed that lack of awareness, misperceptions and biases about liver disease and transplantation, especially living donation, are significant factors contributing to a lack of available organs, according to a press release.

“Our survey results showed that people are willing to donate to save a life, particularly if they know the person, but, potential donors, patients and physicians may not know all available options, and others may have misperceptions about the transplant process,” Abhi Humar, MD, division chief of UPMC Transplant Services, said in the release. “We need to increase awareness and knowledge.” Read more

Rates of deceased donor organs with HCV, HBV, HIV increasing in US

Between 2010 and 2017, the number and percentage of deceased donor organs with a transmissible infectious disease — such as hepatitis C, hepatitis B or HIV — increased in the U.S., which may likely be tied to the ongoing opioid epidemic, according to a recent report from the CDC.

“These findings demonstrate the continuing need for identifying viral bloodborne pathogen infection risk factors among deceased donors to reduce the risk for transmission, monitor posttransplant infection in recipients, and offer treatment if infection occurs,” Winston E. Abara, MD, from the Division of Viral Hepatitis at the CDC, and colleagues wrote. Read more

Live donor liver offers improve transplant survival in patients with HCC

Patients with hepatocellular carcinoma who had a potential live donor at listing for liver transplantation had a significantly lower risk for mortality compared with those who waited for a deceased donor graft, according to recently published data.

According to Nicolas Goldaracena, MD, from the University of Toronto in Canada, and colleagues, the benefits derived from live donor liver transplantation (LDLT) related to a lower dropout rate and shorter waiting period. Read more

Liver preservation technique improves 5-year graft survival

Donation after circulatory death livers treated with hypothermic oxygenated perfusion had similar 5-year posttransplant outcomes as donation after brain death liver transplants and superior results to untreated donation after circulatory death livers, according to a study published in Journal of Hepatology.

“Donation after circulatory death (DCD) organs are increasingly used for liver transplantation, due to the persisting organ shortage and waiting list mortality,” Andrea Schlegel, MD, FEBS, from the University of Birmingham in the United Kingdom, and colleagues wrote. “However, several reports suggest inferior graft survival, increased risk of primary nonfunction (PNF), and biliary complications in DCD livers, with irreversible ischemic cholangiopathy (IC) being a major concern.” Read more