Living vs. Deceased Donor Liver Transplantation Provides Comparable Recovery of Renal Function in Patients With Hepatorenal Syndrome: A Matched Case–Control Study

Abstract

Outcomes of living versus deceased donor liver transplantation in patients with chronic liver disease and hepatorenal syndrome (HRS) was compared using a matched pair study design. Thirty patients with HRS receiving a live donor liver transplantation (LDLT) and 90 HRS patients receiving a full graft deceased donor liver transplantation (DDLT) were compared. LDLT versus DDLT of patients with HRS was associated with decreased peak aspartate aminotransferase levels (339 AE 214 vs. 935 AE 1253 U/L; p ¼ 0.0001), and similar 7-day bilirubin (8.42 AE 7.89 vs. 6.95 AE 7.13 mg/dL; p ¼ 0.35), and international normalized ratio levels No difference was detected between LDLT and DDLT patients regarding graft survival at 1 (80% vs. 82%), at 3 (69% vs. 76%) and 5 years (65% vs. 76%) (p ¼ 0.63), as well as patient survival at 1 (83% vs. 82%), 3 (72% vs. 77%) and 5 years (72% vs. 77%) (p ¼ 0.93). The incidence of chronic kidney disease post-LT (10% vs. 6%; p ¼ 0.4) was similar between both groups. LDLT results in identical long-term outcome when compared with DDLT in patients with HRS.

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

“…They found no strong evidence that the unadjusted survival probabilities for adults with ALF who underwent LDLT were inferior to those who underwent DDLT (29), and recent reports from Japan and Korea demonstrate patient survival exceeding 70% for ALF (30, 31). Several reports from large centers have also shown acceptable outcomes in selected patients with higher MELD scores or renal insufficiency (32–35). …”

Living donor liver transplantation in high Model for End‐Stage Liver Disease score patients

“…Second, warnings regarding inferior outcomes of LDLT in high acuity/high MELD candidates also served as deterrents . This was the context surrounding the 3 seminal reports from 3 leading LDLT centers worldwide specifically focused on LDLT for candidates with HRS, as defined by the International Ascites Club (Table ) …”

“…There was, however, no difference in estimated glomerular filtration rate (eGFR) 3 months after transplant or thereafter. Goldaracena et al from Toronto General Hospital compared 30 HRS patients undergoing LDLT with a matched cohort of 90 patients undergoing DDLT . Patient were matched for, in addition to HRS diagnosis, MELD score within 5 points and need for pretransplant dialysis.…”

Recent advances in understanding and managing liver transplantation

“…LDLT has emerged as a promising alternative to overcome donor shortage 16 . The improvements in LDLT have led to the expansion of the recipient criteria to include patients previously considered not suitable for LT because of older age or co-morbidities.…”