Comparison of Vascular Complications Between Living-donor and Deceased-donor Liver Transplantation – A Systematic Review and Meta-analysis

Abstract

BackgroundVascular complications commonly cause graft loss and morbidity after liver transplantation (LT). Comparative data on the risk of vascular complications are limited. Hence, the present meta-analysis was conducted to analyze the difference in vascular complications between living-donor LT (LDLT) and deceased-donor LT (DDLT). MethodsA literature search of three databases was conducted for studies comparing the incidence of vascular complications with LDLT and DDLT. The event rates and odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model. ResultsA total of 20 studies were included in the final analysis. There was no difference in the incidence of overall vascular complications (9.3%, 95% CI: 6.6 – 12.0 vs. 8.5%, 95% CI: 5.6 – 11.4) between LDLT and DDLT with OR 0.94 (95% CI: 0.73 – 1.21)(15 studies).There was a higher incidence of vascular complications with LDLT in older studies (published before 2013) but not in new studies. When comparing the individual complications, LDLT was associated with a higher incidence of hepatic artery thrombosis (HAT)(3.8%, 95% CI: 2.4 – 5.2 vs. 1.6%, 95% CI: 1.1 – 2.2)with OR 2.20 (95% CI: 1.53 – 3.17)(14 studies)and a significantly lower incidence of intraabdominal bleeding(4.8%, 95% CI: 3.3 – 6.2 vs. 7.9%, 95% CI: 5.0 – 10.7) with OR 0.64 (95% CI: 0.47 – 0.87)(11 studies). However, there was no difference in the incidence (2.1%, 95% CI: 0.5 – 3.8 vs. 1.0%, 95% CI: 0.1 – 1.9) of portal vein thrombosis between LDLT and DDLT with OR 1.85 (95% CI: 0.82 – 4.18) (6 studies). ConclusionDespite a comparable risk of vascular complications between LDLT and DDLT, LDLT was associated with a higher risk of HAT and a lower risk of intraprocedural bleeding. Further studies are required to analyze the effect of donor-recipient characteristics and surgical techniques on the risk of vascular complications.