Outcomes of Living Versus Deceased Donor Liver Transplantation for Acute Liver Failure in the United States

Abstract

Clinical outcomes for living donor liver transplantation (LDLT) for acute liver failure (ALF) in the United States remain to be determined. To address this gap in knowledge, we examined post–liver transplantation outcomes of adults with ALF undergoing LDLT and deceased donor liver transplantation (DDLT) in the United States. We analyzed Organ and Procurement and Transplantation Network data for adults with ALF who were listed for liver transplantation as status 1 or 1A and who underwent LDLT (N = 21) or DDLT (N = 2316) between October 1987 and April 2011. We found no strong evidence that the survival probabilities for adults with ALF who underwent LDLT were inferior to those who underwent DDLT (P = .764). In adults with ALF who underwent LDLT, 1- and 5-year survival probabilities were both 71%; for DDLT these probabilities were 79% and 71%, respectively. In adults with ALF, 1- and 5-year liver graft survival probabilities, respectively, were 62% and 57% for LDLT, and 74% and 66% for DDLT. In these series of adults with ALF who were listed as status 1 or 1A, patient and graft survival rates for LDLT were similar to those for DDLT. Our findings suggest that if deceased donor livers are unavailable, LDLT is an acceptable option in experienced centers for adults with ALF.

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

“…Urrunga et al analyzed OPTN data for adults with acute liver failure (ALF) who were listed for liver transplantation as Status 1 or 1A and underwent LDLT (N = 21) or DDLT (N = 2316) between October 1987 and April 2011. 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).…”

Liver transplantation and atrial fibrillation: A meta-analysis

“…Liver transplantation is the treatment of choice for end-stage liver diseases[ 10 , 13 ]. In 2017, around 8000 patients all over the United State suffered from end-stage liver disease receiving liver transplantation and the number trends to increase 3% to 5% annually in the past 20 years along with the excellent outcomes with almost 95% survival rate at 1-year post-procedure and some patients could live even more than 30 years after liver transplantation[ 14 - 17 ]. Recent advances in basic and clinical sciences, including surgical technique, immunosuppressive therapy and postoperative supportive care, have led to the substantial improvement in quality of life and survival after liver transplantation[ 18 , 19 ].…”

Good outcome of living donor liver transplantation in drug‐induced acute liver failure: A single‐center experience

“…The authors identified vasopressor requirement, estimated glomerular filtration rate, serum sodium concentration, recipient age, and donor age as significant predictors of transplant outcome . In a study from the United states, Urrunaga et al . compared LDLT (n=21) to DDLT (n=2316) for ALF and 1‐ and 5‐year survival probabilities were both 71% for LDLT and 79% for DDLT.…”

“…Among LDLT patients, cumulative patient survival rates at 1, 5, and 10 years were 79%, 74%, and 73%. 15 Kaido et al 16 18 In a study from the United states, Urrunaga et al 19 compared LDLT (n=21) to DDLT (n=2316) for ALF and 1-and 5-year survival probabilities were both 71% for LDLT and 79% for DDLT.…”

“…The laboratory values of ATT-related ALF patients (n=14) were as follows: serum bilirubin 17.8, INR 2.7 (2.0-3.1), creatinine 0.6 (0.5-0.76) mg/dL, and jaundice to encephalopathy interval 4 (3-9) days.The median waiting before liver transplantation was 1 (1-3) days. All patients underwent right lobe LDLT with a GRWR of 1.02 (0.89-1.12).The ICU stay was 5 (5-7) days, and total hospital stay was 17(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) days after LDLT. Complications in the postop course included blood stream infections in three, anastomotic biliary strictures in two, which were managed endoscopically, CMV viremia in three, and acute cellular rejection that responded to steroids in five patients.…”