Live liver transplants can save more lives in the US

A new study in the Journal of Hepatology says liver transplants from living donors can reduce waiting times and deaths.

Patients awaiting liver transplantation require more donor livers than are available, and more than 15% of patients on the waiting list die after one year.

That shows a new international study Living Donor Liver Transplantation (LDLT) should be used more extensively in Western countries and that the imbalance between organ supply and demand should be corrected.

The results of this study were published in Elsevier’s Journal of Hepatology, which also serves as the official publication of the European Association for the Study of the Liver.

Living Donor Liver Transplant (LDLT) is the process by which a healthy donor’s liver is transplanted into a patient whose own liver is failing. A few months after surgery, the donor’s remaining liver begins to grow back, returning to its normal size, volume, and capacity. Although the wait for a transplant from a deceased donor can be more than five years, LDLT is still relatively uncommon in Western countries compared to Asia.

Finding differences in transplant outcomes and other transplant characteristics could help identify ways to improve healthcare and show whether expanding LDLT practices in countries that primarily use DDLT is a good idea.

According to Gonzalo Sapisochin, MD, PhD, MSc, Division of General Surgery, University Health Network, Toronto, ON, Canada, there is growing interest in finding ways to deal with the growing need for transplants and the unacceptably high mortality rate associated with the waiting list for liver transplants.

“One such approach,” says the researcher, “is LDLT, which can increase the number of grafts available for transplantation. However, short-term and long-term results must be maintained for both donors and recipients.

“We therefore attempted to compare donor and recipient characteristics and post-transplant outcomes after LDLT.”

This is a retrospective multicenter study of patients 18 years and older who received primary LDLT between January 2008 and December 2018 as reported by three national liver transplant registries: UNOS (US), NHSBT (UK) and the Canadian Organ Replacement Registry (CORR; Canada).

Patients who received a second transplant or a transplant of more than one organ were not eligible. Researchers examined the three registries and compared recipient and donor characteristics, trends over time, and outcomes after LDLT. In addition, they aimed to compare LDLT and DDLT scores within each nation.

There were a total of 2,954 LDLTs in these three countries. Of these, 2,328 were in the US, 529 in Canada and 97 in the UK. Over time, Canada implemented most LDLT treatments.

Despite the comparatively low use of LDLT in western countries, the researchers were pleasantly surprised to learn that the long-term results were excellent.

Patient survival rates at 1, 5, and 10 years in the US were 92.6%, 82.8%, and 70.0%, respectively; 96.1%, 89.9% and 82.2% in Canada; and 91.4%, 85.4% and 66.7% in the UK.

This LDLT analysis shows that despite the lower use of LDLT in Western countries compared to Asian countries, long-term survival is great. Furthermore, there is no statistically significant difference in mortality risk between these three nations.

The results offer “support for the increased use of LDLT in western countries,” emphasized Dr. Sapisochin, as “it offers an opportunity to reduce the imbalance between organ supply and demand, thereby providing waiting-listed candidates with an opportunity for earlier transplantation and reduced mortality in the transplant-waiting list.”

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