Living Donor and Deceased Donor Liver Transplantation for Autoimmune and Cholestatic Liver Diseases—An Analysis of the UNOS Database

Kashyap, Randeep; Safadjou, Saman; Chen, Rui; Mantry, Parvez S.; Sharma, Rajeev; Patil, Vrishali P.; Maloo, Manoj; Ryan, Charlotte; Marroquin, Carlos E.; Barry, Christopher T.; Ramaraju, Gopal; Maliakkal, Benedict; Orloff, Mark S.

doi:10.1007/s11605-010-1256-1

Cited by 78 publications

(52 citation statements)

References 26 publications

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“…There was substantial improvement over time, and superior outcomes of LDLT in autoimmune hepatitis and cholestatic liver disease at experienced centers (12). Kashyap et al performed a retrospective analysis of US national data for patients transplanted between February 2002 and October 2006, and demonstrated higher unadjusted survival after LDLT compared to DDLT; for patients with autoimmune hepatitis, PSC, and PBC, they found similar outcomes for the two graft types after adjusting for covariates (14). …”

Section: Discussionmentioning

confidence: 99%

“…Early reports demonstrating inferior outcomes in LDLT compared to DDLT (5), and donor morbidity and mortality may have contributed to the limited growth in North America (6, 7). As experience increased, early post-transplant outcomes improved and single center reports demonstrated similar or even better outcomes of LDLT compared to DDLT (8–11), and recent registry studies have demonstrated comparable outcomes between LDLT and DDLT across many indications (12–14). Analyses from large unfunded registries, however, provide less detailed information than is possible from a federally supported multicenter observational cohort study.…”

Section: Introductionmentioning

confidence: 99%

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Defining Long-term Outcomes With Living Donor Liver Transplantation in North America

et al. 2015

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Objective To compare long-term survival of living donor liver transplant (LDLT) at experienced transplant centers to outcomes of deceased donor liver transplant (DDLT) and identify key variables impacting patient and graft survival. Summary Background Data The Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) is a prospective multicenter NIH study comparing outcomes of LDLT and DDLT and associated risks. Methods Mortality and graft failure for 1427 liver recipients (963 LDLT) enrolled in A2ALL transplanted between 1/1/1998 and 1/31/2014 at 12 North American centers with median follow-up 6.7 years were analyzed using Kaplan-Meier and multivariable Cox models. Results Survival probability at 10 years was 70% for LDLT and 64% for DDLT. Unadjusted survival was higher with LDLT (HR=0.76, p=0.02) but attenuated after adjustment (HR=0.98, p=0.90) as LDLT recipients had lower mean MELD (15.5 vs 20.4) and fewer were transplanted from ICU, inpatient, on dialysis, ventilated, or with ascites. Post-transplant ICU days were less for LDLT. For all recipients female gender and primary sclerosing cholangitis were associated with improved survival, while dialysis and older recipient/donor age were associated with worse survival. Higher MELD score was associated with increased graft failure. Era of transplantation and type of donated lobe did not impact survival in LDLT. Conclusions LDLT provides significant long-term transplant benefit resulting in transplantation at a lower MELD score, decreased death on waitlist, and excellent post-transplant outcomes. Recipient diagnosis, disease severity, renal failure, and ages of recipient and donor should be considered in decision-making regarding timing of transplant and donor options. Clinical Trials ID NCT00096733.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Defining Long-term Outcomes With Living Donor Liver Transplantation in North America

et al. 2015

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“…The overall patient and graft 5-year survival rates in PSC recipients are excellent: 95.4% and 89.6%, respectively[83]. Patients receiving transplants for PSC have disease-specific complications (excluding the usual post-transplant complications) that might lead to increased morbidity and mortality rates.…”

Section: Psc After Liver Transplantationmentioning

confidence: 99%

Inflammatory bowel disease in liver transplanted patients

Kanižaj

Mijić

2017

WJG

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Most common hepatobiliary manifestation of inflammatory bowel disease (IBD) are primary sclerosing cholangitis (PSC) and autoimmune hepatitis, ranking them as the main cause of liver transplantation (LT) in IBD setting. Course of pre-existing IBD after LT differs depending on many transplant related factors. Potential risk factors related to IBD deterioration after LT are tacrolimus-based immunosuppressive regimens, active IBD and cessation of 5-aminosalicylates at the time of LT. About 30% patients experience improvement of IBD after LT, while approximately the same percentage of patients worsens. Occurrence of de novo IBD may develop in 14%-30% of patients with PSC. Recommended IBD therapy after LT is equivalent to recommendations to overall IBD patients. Anti-tumor necrosis factor alpha appears to be efficient for refractory IBD. Due to potential side effects it needs to be applied with caution. In average 9% of patients require proctocolectomy due to medically refractory IBD or colorectal carcinoma. The most frequent complication in patients who undergo proctocolectomy with ileal-pouch anal anastomosis is pouchitis. It is still undeterminable if LT adds to risk of developing pouchitis in PSC patients. Annual colonoscopies are recommended as surveillance and precaution of colonic malignancies.

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“…In a subsequent paper the same group compared the survival outcome of PSC patients either receiving a live or a deceased donor allograft using the United Network for Organ Sharing (UNOS) database [17]. On multivariate analysis, after adjusting for age and MELD score, the type of donor was not found to be statistically significant.…”

Section: Recurrent Primary Sclerosing Cholangitis In Live Donor Livermentioning

confidence: 99%

Live donor liver transplantation for primary sclerosing cholangitis: is disease recurrence increased?

Graziadei¹

2011

Current Opinion in Gastroenterology

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These data suggest that patients with PSC undergoing live donor liver transplantation, especially with biologically related donors, may have a higher risk to develop recurrent disease compared with the deceased donor setting. However, this fact has to be interpreted with great caution, primarily due to the rather small number of patients. Further studies analyzing pooled data of all transplant centers performing live donor liver transplantations are needed to confirm these findings.

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Living Donor and Deceased Donor Liver Transplantation for Autoimmune and Cholestatic Liver Diseases—An Analysis of the UNOS Database

Abstract: The overall survival outcomes of LDLT were similar to DDLT in our patients with autoimmune and cholestatic liver diseases. It appears from our study that after adjusting for age and MELD score donor type does not significantly affect the outcome.

Cited by 78 publications

References 26 publications

Defining Long-term Outcomes With Living Donor Liver Transplantation in North America

Defining Long-term Outcomes With Living Donor Liver Transplantation in North America

Inflammatory bowel disease in liver transplanted patients

Live donor liver transplantation for primary sclerosing cholangitis: is disease recurrence increased?

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