Comparing the Outcomes of Deceased-Donor and Living-Donor Liver Re-Transplantation In Adult Patients

Abstract

Patients with liver graft failures have an extremely low chance of finding a cadaveric graft in countries with a scarcity of deceased donors. We compared the outcomes of liver re-transplantation with living-donor liver grafts (re-LDLT) and deceased-donor liver grafts (re-DDLT) in adult patients (>18 years). The medical records of 1513 (1417 [93.6%] LDLT and 96 [6.3%] DDLT) patients who underwent liver transplantation at Memorial Hospital between January 2011 and October 2022 were reviewed. Forty patients (24 adults and 16 pediatric) were re-transplanted (2.84%); 24 adult patients (2.72%: 25 re-LDLT, 1 patient with second re-LDLT) were divided into 2 groups: re-DDLT (n=6) and re-LDLT (n=18). The groups were compared in demographics, pre-, peri-, postoperative characteristics, and outcomes. The overall survival rates were 91.7%, 79.2%, 75.0%, and 75% for <30 days, 31 to 90 days, 1, and 3 years, respectively. The LDLT group was significantly younger (P=.022), had smaller graft weight (P=.03), shorter mechanical ventilation (P=.036) but longer operation time (P=.019), and hospitalization period (P=.003). The groups were otherwise comparable. There was no statistically significant difference in survival rates between the groups (P=.058), although the re-LDLT group had an evidently higher survival rate (88.9% and 83.3 % vs 50.0%). Re-LDLT has shown comparable outcomes to re-DDLT, if not better (even not far from significance P=.058). These results may encourage performing re-LDLTs in patients with indications for re-LT without worrying about low chances of survival, especially in countries with limited sources of deceased donors.