Living-Donor Liver Transplant and Improved Post-Transplant Survival in Patients with Primary Sclerosing Cholangitis

Abstract

Primary sclerosing cholangitis (PSC) is the leading indication of liver transplantation (LT) among autoimmune liver disease patients. There is a scarcity of studies comparing survival outcomes between living-donor liver transplants (LDLT)s and deceased-donor liver transplants (DDLTs) in this population. Using the United Network for Organ Sharing database, we compared 4679 DDLTs and 805 LDLTs. Our outcome of interest was post-LT patient survival and post-LT graft survival. A stepwise multivariate analysis was performed, adjusting for recipient age, gender, diabetes mellitus, ascites, hepatic encephalopathy, cholangiocarcinoma, hepatocellular carcinoma, race, and the model for end-stage liver disease (MELD) score; donor’ age and sex were also included to the analysis. According to univariate and multivariate analysis, LDLT had a patient and graft survival benefit compared to DDLT (HR, 0.77, 95% CI 0.65–0.92; p < 0.002). LDLT patient survival (95.2%, 92.6%, 90.1%, and 81.9%) and graft survival (94.1%, 91.1%, 88.5%, and 80.5%) at 1, 3, 5, and 10 years were significantly better than DDLT patient survival (93.2%, 87.6%, 83.3%, and 72.7%) and graft survival (92.1%, 86.5%, 82.1%, and 70.9%) (p < 0.001) in the same interval. Variables including donor and recipient age, male recipient gender, MELD score, diabetes mellitus, hepatocellular carcinoma, and cholangiocarcinoma were associated with mortality and graft failure in PSC patients. Interestingly, Asians were more protected than Whites (HR, 0.61; 95% CI, 0.35–0.99; p < 0.047), and cholangiocarcinoma was associated with the highest hazard of mortality (HR, 2.07; 95% CI, 1.71–2.50; p < 0.001) in multivariate analysis. LDLT in PSC patients were associated with greater post-transplant patient and graft survival compared to DDLT patients.

Recipient Survival among Living Donor vs. Deceased Donor Liver Transplants for Acute Liver Failure in the United States

“…We found that the presence of ascites, hepatic encephalopathy, and the need for dialysis were all significantly less common in patients who underwent LDLT compared to those of patients who underwent DDLT. Similarly, another study reported that patients with primary sclerosing cholangitis who underwent LDLT less commonly had ascites and hepatic encephalopathy compared to those whose underwent DDLT, although this study was not conducted in patients with ALF [ 32 ].…”

Two Decades of Liver Transplants for Primary Biliary Cholangitis: A Comparative Study of Living Donors vs. Deceased Donor Liver Transplantations

“…Additionally, we opted to further stratify DDLT into distinct categories, namely DBD and DCD, a comparison that has only been explored in one other study [19]. However, it is important to note that this comparison study encompassed including another cholestatic liver disease such as PSC, which has a distinct underlying pathogenesis, prognosis, and course of disease after LT [28]. With the implementation of the MELD 3.0, which introduces adjustments to the MELD score, particularly including female sex, we anticipated changes in the waiting list outcomes and post-LT outcomes after DDLT or LDLT in PBC recipients in the subsequent years [29].…”

The role of living donor liver transplantation in treating intrahepatic cholangiocarcinoma

“…Within this series, 55 out of 805 LDLT cases culminated in an iCC diagnosis, with an overall survival rate for LDLT recipients reaching 81.9%. Intriguingly, multivariate analysis identified concurrent cholangiocarcinoma as a significant predictor of mortality (HR: 2.07; 95% CI: 1.71–2.50; p < 0.001) ( 31 ). The second largest series was published in 2020 by Bhatti et al., who analyzed the experience in LDLT for cholangiocarcinoma in cases with early stages of the disease and incidental diagnoses.…”