Adult living donor versus deceased donor liver transplantation: A 10-year prospective single center experience

Fisher, Robert A.; Cotterell, Adrian; Maluf, Daniel G.; Stravitz, R. Todd; Ashworth, April; Nakatsuka, M.; Sterling, Richard K.; Luketic, Velimir A.; Behnke, Martha; Posner, Marc P.

doi:10.1016/s1665-2681(19)31742-9

Cited by 35 publications

(33 citation statements)

References 25 publications

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“…Furthermore, for emergency patients with fulminant hepatic failure, LDLT has often proved to be an optimal selection and can provide timely grafts to save their lives . It has been demonstrated by many cohort studies that LDLT does not show a weakness in terms of long‐term overall survival in comparison with DDLT . Even for patients with HCC, the overall survival rates of the 2 groups after listing (intention to treat) and after LT (only for those patients with HCC confirmed in the explanted liver) are quite comparable …”

Section: Discussionmentioning

confidence: 99%

“…It is generally accepted by most researchers that LDLT can lead to long‐term survival rates for adult patients comparable to those associated with DDLT, and this has been shown in many comparative cohorts . However, LDLT is criticized for its underlying higher rate of biliary complications in comparison with DDLT, and it remains characterized by its technical complexity and ethical controversies.…”

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confidence: 99%

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Operative outcomes of adult living donor liver transplantation and deceased donor liver transplantation: A systematic review and meta-analysis

2014

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Living donor liver transplantation (LDLT) has emerged as an alternative to deceased donor liver transplantation (DDLT) because of the increasing number of patients waiting for liver transplantation (LT). However, whether it can achieve operative outcomes similar to those achieved with DDLT for adult patients remains controversial. We conducted this metaanalysis to compare the operative outcomes of LDLT and DDLT recipients. A literature search was performed to identify clinical controlled studies comparing LDLT and DDLT that were published before October 2013. Four perioperative outcomes [duration of the recipient operation (DRO), red blood cell (RBC) transfusion requirement, length of the hospital stay, and cold ischemia time (CIT)] and 5 postoperative complication outcomes (biliary complications, vascular complications, intraabdominal bleeding, perioperative death, and retransplantation) were the main outcomes assessed. Nineteen studies with a total of 5450 patients were included in the meta-analysis. In comparison with DDLT, LDLT was associated with a significantly longer DRO and a shorter CIT. We found that biliary complications [odds ratio (OR) 5 3.08, 95% confidence interval (CI) 5 1.97-4.81, P < 0.001], vascular complications (OR 5 2.16, 95% CI 5 1.32-3.54, P 5 0.002), and retransplantation (OR 5 1.76, 95% CI 5 1.09-2.83, P 5 0.02) occurred more frequently for LDLT recipients, and the subgroup analysis indicated that the biliary complication rate decreased dramatically with greater LDLT experience. No significant difference was observed in RBC transfusion requirements, the lengths of hospital stays, intra-abdominal bleeding rates, or perioperative mortality between LDLT and DDLT recipients. In conclusion, LDLT is associated with a higher rate of surgical complications after transplantation. A reduction of postoperative complication rates can be achieved as centers gain greater experience with LDLT. However, LDLT is still an excellent alternative to DDLT because it facilitates access to LT.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Operative outcomes of adult living donor liver transplantation and deceased donor liver transplantation: A systematic review and meta-analysis

2014

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“…In the United Kingdom, the active waiting list for liver transplantation has more than doubled in the past decade (264 in 2004‐2005 to 549 in 2013‐2014), highlighting a growing discrepancy between organ demand and availability. In combination with sustained improvements in surgical expertise and posttransplantation care, there has been renewed interest in living donor and split‐liver transplantation . Furthermore, expansion of the liver allograft criteria to include previously unconsidered “marginal donors” has involved donor livers from older patients, and from those with underlying pathologies or prolonged ischemic periods …”

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confidence: 99%

Decision modeling in donation after circulatory death liver transplantation

et al. 2017

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Donation after circulatory death (DCD) liver allografts are increasingly used for transplantation. However, the posttransplantation clinical and quality of life outcomes of DCD recipients are traditionally considered to be inferior compared with donation after brain death (DBD) allograft recipients. Decision making for such marginal organs can be difficult. This study investigated the optimal decision to accept or decline a DCD liver allograft for a patient based on their current health. A Markov decision process model was constructed to predict the 5-year clinical course of patients on the liver transplant waiting list. Clinical outcomes were determined from the UK transplant registry or appropriate literature. Quality-adjusted life years (QALYs) were determined using the condition-specific short form of liver disease quality of life (SF-LDQoL) questionnaire. There were 293/374 (78.3%) eligible patients who completed the SF-LDQoL questionnaire. A total of 73 respondents (24.9%) were before transplant and 220 were after transplant (DBD recipient, 56.3%; DCD recipient, 8.5%; ischemic cholangiopathy patient, 2.4%; retransplant recipient, 7.9%). Predictive modeling indicated that QALYs gained at 5 years were significantly higher in DCD recipients (3.77; 95% confidence interval [CI], 3.44-4.10) compared with those who remained on the waiting list for a DBD transplant with Model for End-Stage Liver Disease (MELD) scores of 15-20 (3.36; 95% CI, 3.28-3.43), or >20 (3.07; 95% CI, 3.00-3.14). There was no significant advantage for individuals with MELD scores <15 (3.55; 95% CI, 3.47-3.63). In conclusion, this model predicts that patients on the UK liver transplant waiting list with MELD scores >15 should receive an offered DCD allograft based on the QALYs gained at 5 years. This analysis only accounts for donor-recipient risk pairings seen in current practice. The optimal decision for patients with MELD scores <15 remains unclear. However, a survival benefit was observed when a DCD organ was accepted. Liver Transplantation 23 594-603 2017 AASLD.

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“…Whereas the survival benefit of LDLT relative to DDLT at 10 years has been confirmed, the detrimental effect of severe renal dysfunction on mortality after LT will continue to negatively affect survival after DDLT . The future is bright for LDLT recipients: with experience gained worldwide, not only has the related morbidity dropped to below the thresholds for LT established in national studies like the US A2ALL cohort, but underserved recipients who would never be eligible for DDLT have been added to the pool of successful LT recipients . There is now strong evidence, magnified at experienced centres, of LDLT providing a sustained benefit to recipients with low MELD scores (<15), and a lower mortality on the waiting list is only part of the reason .…”

Section: Living Donor Liver Transplantation: Update and Perspectivesmentioning

confidence: 99%

Specific issues concerning the management of patients on the waiting list and after liver transplantation

Burra

Giannini

Caraceni

et al. 2018

Liver International

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The present document is a second contribution collecting the recommendations of an expert panel of transplant hepatologists appointed by the Italian Association for the Study of the Liver (AISF) concerning the management of certain aspects of liver transplantation, including: the issue of prompt referral; the management of difficult candidates; malnutrition; living related liver transplants; hepatocellular carcinoma; and the role of direct acting antiviral agents before and after transplantation. The statements on each topic were approved by participants at the AISF Transplant Hepatology Expert Meeting organized by the Permanent Liver Transplant Commission in Mondello on 12-13 May 2017. They are graded according to the GRADE grading system.

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Adult living donor versus deceased donor liver transplantation: A 10-year prospective single center experience

Cited by 35 publications

References 25 publications

Operative outcomes of adult living donor liver transplantation and deceased donor liver transplantation: A systematic review and meta-analysis

Operative outcomes of adult living donor liver transplantation and deceased donor liver transplantation: A systematic review and meta-analysis

Decision modeling in donation after circulatory death liver transplantation

Specific issues concerning the management of patients on the waiting list and after liver transplantation

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