Resource Utilization of Living Donor Versus Deceased Donor Liver Transplantation Is Similar at an Experienced Transplant Center

Abstract

Although living donor liver transplantation (LDLT) has been shown to decrease waiting-list mortality, little is known of its financial impact relative to deceased donor liver transplantation (DDLT). We performed a retrospective cohort study of the comprehensive resource utilization, using financial charges as a surrogate measure-from the pretransplant through the posttransplant periods-of 489 adult liver transplants (LDLT n = 86; DDLT n = 403) between January 1, 2000, through December 31, 2006, at a single center with substantial experience in LDLT. Baseline characteristics differed between LDLT versus DDLT with regards to age at transplantation (p = 0.02), male gender (p < 0.01), percentage Caucasians (p < 0.01) and transplant model for end-stage liver disease (MELD) score (p < 0.01). In univariate analysis, there was a trend toward decreased total transplant charges with LDLT (p = 0.06), despite increased surgical charges associated with LDLT (p < 0.01). After adjustment for the covariates that were associated with financial charges, there was no significant difference in total transplant charges (p = 0.82). MELD score at transplant was the strongest driver of resource utilization. We conclude that at an experienced transplant center, LDLT imposes a similar overall financial burden than DDLT, despite the increased complexity of living donor surgery and the addition of the costs of the living donor. We speculate that LDLT optimizes transplantation by transplanting healthier and younger recipients.

Retrograde arterial flush of the liver graft in living donor liver transplantation may ameliorate post‐transplantational cholestasis – a prospective randomized study

“…For the etiologies of anastomotic biliary stricture in LDLT, multiple risk factors such as number and size of bile ducts, blood supply for the bile ducts, and HA complications have been suggested (22)(23)(24)(25), so the causes should be multifactorial. The incidence of biliary complications in LDLT in this study was high, and the incidence of biliary anastomotic strictures in our patients was 30%, which is acceptable when compared with previous reports (16)(17)(18)(19)(20)(21)(22)(23)(24)(25). With at least one-yr follow-up, our results showed a lower incidence of biliary strictures in the RGAF group, but without statistical significance (23.3% vs. 36.7%, p = 0.260).…”

“…After two decades of effort, the results of LDLT are comparable with deceased donor whole and reduced-sized liver transplantation, and even better than split-liver transplantation (16)(17)(18)(19)(20)(21). However, more severe and prolonged postoperative cholestasis and a higher incidence of biliary stricture have been noted in LDLT (18,19,(22)(23)(24)(25)(26).…”

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

“…After independent reviews, 30 full‐text articles were excluded for the following reasons: (1) 11 studies were based on overlapping cohorts from the same institution, (2) 4 studies were based on UNOS or SRTR databases, and (3) 15 studies lacked available data. Finally, 19 published clinical cohort studies (4 prospective cohorts and 15 retrospective cohorts) were included in the meta‐analysis …”

“…Finally, 19 published clinical cohort studies (4 prospective cohorts and 15 retrospective cohorts) were included in the meta-analysis. 6,7,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] The characteristics of the 19 included studies are presented in Table 1. All the studies were well designed to compare the 2 arms: LDLT and DDLT.…”

“…Significant heterogeneity among the 5 studies was found for RBC transfusion requirements (P 5 0.006, I 2 5 72%); therefore, a random-effect model was used to combine the data. Pooled results revealed that LDLT and DDLT 16 4 2 3 9 Shah et al 17 3 2 3 8 Al-Sebayel et al 18 3 2 3 8 Schmeding et al 19 3 2 3 8 Selzner et al 20 3 2 3 8 Freise et al 21 3 2 3 8 G omez et al 22 3 0 3 6 Gallegos-Orozco et al 23 3 2 3 8 Fisher et al 7 4 1 3 8 Lai et al 24 3 1 3 7 Shin et al 25 3 2 1 6 Merion et al 26 3 2 3 8 Li et al 27 3 2 3 8 Jain et al 28 3 2 3 8 Reichman et al 6 3 2 3 8 Jiang et al 29 3 2 3 8 Figure 2. Meta-analysis of controlled trials comparing DROs for LDLT and DDLT recipients on the basis of a random-effect model.…”