Liver Transplants from Living Donors Have Poorer Outcomes Depending on Center Experience: Presented at AASLD

By Crystal Phend

November 23, 2005

SAN FRANCISCO -- Patients typically receive liver transplants from living donors sooner but they can also pay a price in terms of survival, disease recurrence and graft survival, depending on the transplant center's level of experience with this type of transplantation.

"Conflicting reports are available," said one lead author, Norah A. Terrault, MD, MPH, Assistant Professor of Medicine, Gastroenterology and Liver Transplantation, University of California, San Francisco, California, United States.

Dr. Terrault presented findings of her study here on November 13^th at the annual meeting of the American Association for the Study of Liver Diseases (AASLD).

Both studies were retrospective analyses of data from hepatitis C virus-infected liver transplant recipients in the nine-center Adult to Adult Living Donor Liver Transplant Cohort Study (A2ALL).

All patients were candidates for living donor liver transplants. Those who received an organ from a dead donor either did not have an appropriate living donor available or were offered a liver from a dead donor prior to the planned living donor transplant.

Laura Kulik, MD, Assistant Professor of Medicine, Northwestern University, Chicago, Illinois, United States, presented an analysis of survival and liver cancer recurrence in patients receiving livers from living versus deceased donors on November 13^th.

In Dr. Kulik's study of patients with cirrhosis and known hepatocellular cancer, 56 patients received a liver transplant from a living and 31 had dead donors.

Patient characteristics, including Model for End-Stage Liver Disease (MELD) scores and tumor stage at transplantation, were statistically similar between groups. Patients receiving living donor transplants had a significantly shorter waiting time after listing (162 vs. 471 days).

After about 2 years of follow-up, none of the patients in the dead donor group had recurrence of hepatocellular cancer compared to 17 in the living donor group. At 3 years, living donor transplant was associated with significantly more recurrence (43% versus 0%).

The 3-year recurrence-free survival was 46% in the living donor group compared to 79% in the dead donor group, but this was not a significant difference.

Transplant donor type was not significantly associated with mortality or the combined endpoint of mortality or liver cancer recurrence.

The researchers concluded that the benefits of a shorter waiting time for the living donor recipients are offset by a higher hepatocellular carcinoma recurrence rate regardless of initial tumor stage.

In Dr. Terrault's study, results showed that the level of experience of the center where the transplant was performed could account for the difference. "Living donor liver transplant is technically very demanding," she said.

Her team compared graft failure and risk of advanced fibrosis (Ishak fibrosis score of 3 or more) between living and dead donors, according to whether or not the surgery was among the first 20 living donor cases at each center.

Of the 274 patients, 94 received an organ from a dead donor and 180 from a live donor. Patient characteristics were similar between groups except that the living donor group had a lower MELD score at transplant.

Transplant survival was significantly lower for the living donor group compared in unadjusted and multivariable analyses but not for patients treated in experienced centers (after the first 20 living donor transplants).

Patient survival was likewise similar for patients treated in an experienced center.

Dr. Terrault's group concluded that once a center had experience with living donors, the recipient outcome would be similar to those who receive transplants from dead donors.

Presentation title: Transplant Center Experience Explains Differences in the Risk of Graft Failure Between Hepatitis C Virus (HCV)-Infected Recipients of Living Donor (LDLT) and Deceased Donor (DDLT) Liver Transplant Recipients. Abstract 7.

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This article posted December 18, 2005.