Abstract
Background/AimsThe number of people undergoing living donor liver transplantation (LDLT) has increased rapidly in many transplant centres. Patients considering LDLT need to know whether LDLT is riskier than deceased donor liver transplantation (DDLT). The aim of this study was to compare the outcomes of patients undergoing LDLT versus DDLT.MethodsA total of 349 patients with benign liver diseases were recruited from 2005 to 2011 for this study. LDLT was performed in 128 patients, and DDLT was performed in 221 patients. Pre- and intra-operative variables for the two groups were compared. Statistically analysed post-operative outcomes include the postoperative incidence of complication, biliary and vascular complication, hepatitis B virus (HBV) recurrence, long-term survival rate and outcomes of emergency transplantation.ResultsThe waiting times were 22.10±15.31 days for the patients undergoing LDLT versus 35.81±29.18 days for the patients undergoing DDLT. The cold ischemia time (CIT) was 119.34±19.75 minutes for the LDLT group and 346±154.18 for DDLT group. LDLT group had higher intraoperative blood loss, but red blood cell (RBC) transfusion was not different. Similar ≥ Clavien III complications, vascular complications, hepatitis B virus (HBV) recurrence and long-term survival rates were noted. LDLT patients suffered a higher incidence of biliary complications in the early postoperative days. However, during the long-term follow-up period, biliary complication rates were similar between the two groups. The long-term survival rate of patients undergoing emergency transplantation was lower than of patients undergoing elective transplantation. However, no significant difference was observed between emergency LDLT and emergency DDLT.ConclusionsPatients undergoing LDLT achieved similar outcomes to patients undergoing DDLT. Although LDLT patients may suffer a higher incidence of early biliary complications, the total biliary complication rate was similar during the long-term follow-up period.
Highlights
Liver transplantation is perceived as the only curative treatment for patients with end-stage liver disease
Previous investigations have suggested that patients undergoing living donor liver transplantation (LDLT) may have a higher incidence of biliary and vascular complications and a lower long-term survival rate than patients undergoing deceased donor liver transplantation (DDLT).[9,10]
Patients considering LDLT should know whether the risk, severity of complications and long-term survival are similar to DDLT
Summary
Liver transplantation is perceived as the only curative treatment for patients with end-stage liver disease. 20–25% of patients with liver failure die while waiting for a liver transplant, and another 20– 30% of patients with hepatocellular carcinoma drop off the waiting list because of tumour progression.[1,2,3,4] Since Strong et al.[5] performed the first successful LDLT in 1989, LDLT has emerged as the alternative life-saving treatment to DDLT. LDLT has a smaller biliary and vascular calibre and an additional transection step, which may potentially increase the surgical risk and the incidence of postoperative complications. Previous investigations have suggested that patients undergoing LDLT may have a higher incidence of biliary and vascular complications and a lower long-term survival rate than patients undergoing DDLT.[9,10] As surgical techniques and postoperative managements continue to advance, the outcomes of LDLT have continued to improve. Patients considering LDLT should know whether the risk, severity of complications and long-term survival are similar to DDLT. Few reports exist in the literature addressing these topics
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