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Living-donor Liver Transplant Offers Many Advantages Over Deceased Donor

by Dr. Lakshmi Venkataraman on July 15, 2019 at 4:54 PM
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Highlights:

Living-donor liver transplant (LDLT) may offer better patient outcomes such as improved survival and fewer complications including lesser cost compared to deceased donor liver transplant (DDLT), according to a recent study at the UPMC (University of Pittsburgh Medical Center) Thomas E. Starzl Transplantation Institute and the University of Pittsburgh School of Medicine.


The findings of the study appear online in the journal Annals of Surgery, and underscores the fact that living-donor liver transplant is a viable option and should be considered for the over 14,000 patients currently on the waiting list and many others who are ineligible to be on the list under current policy regulations.

‘Currently, patients with liver failure are on a waiting list to receive a suitably matching deceased donor liver, and nearly 25% die and others develop more complications during the waiting period, making the patient outcome more unfavorable post-transplant. Only less than 5% of liver transplants are from a living donor.’

According to Abhinav Humar, M.D., chief of transplant services at UPMC, lead author of the study and clinical director of the transplantation institute, "Living-donor liver transplants, in tandem with deceased-donor liver transplants, represents an opportunity to significantly decrease the risk of wait-list mortality, and gives us the ability to transplant a person sooner."

Comparing Outcomes of Live Vs. Deceased Donor Liver Transplant

The current retrospective study analyzed 245 adult live donor liver transplants and 592 deceased-donor liver transplants done at the UPMC over the last 10 years to compare survival rates and other patient outcomes such as complications, costs, recovery duration and utilization of resources. The patients were closely monitored for at least two years following transplant. UPMC has the biggest live-donor liver transplant program in the US.

The key findings of the study included

The findings of the study suggest that living-donor liver transplant could potentially improve survival rates and reduce complications for the thousands of patients with liver failure needing a transplant.

"Living-donor liver transplant should be considered the first and best option for most patients with liver disease," Humar said. "It is not only an option for those on the waiting list but could perhaps offset the fact that not everyone who may benefit from transplant qualifies to receive a deceased-donor transplant based on today's current rules of allocation."

Success Story of Live Donor Liver Transplants in UPMC

UPMC has the distinction of leading the country in live donor liver transplants in the last two years and is the only center in the U.S. to have done more live than deceased donor liver transplants.

Living-donor Liver Transplant

In a living-donor liver transplant, a portion of the liver from a healthy living donor is removed surgically and transplanted into a recipient after surgically removing his diseased liver. The donor's liver regenerates, i.e., grows back to its original size within a short period, latest by eight weeks. This allows more persons to become liver donors.

Donor eligibility criteria

The reasons for low rates of living-donor liver transplant include ethical concerns of potential complications in the donor following surgery for the benefit of someone else and immunological factors that may influence transplant outcome.

It is suggested that the decision to use a live or deceased donor should depend on the patient's status, availability of suitable match, and level of expertise of the center performing the procedure.

In summary, live donor liver transplants could be a way forward to improve survival and offer a ray of hope and make a huge difference for the hundreds of families who have a patient needing a liver transplant.

References:

  1. New Study Highlights Advantages of Living-Liver Donation - (https:www.upmc.com/media/news/071219-ldlt-ddlt-paper)
  2. Living Donor Liver Transplant - (https:transplant.surgery.ucsf.edu/conditions--procedures/living-donor-liver-transplant.aspx)


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