Low Volume Deceased Donor Liver Transplantation Alongside Living Donor Liver Transplantation

Abstract

Background: Living donor liver transplantation (LDLT) is to date the only realistic lifesaving treatment alternative to deceased donor liver transplantation. With advances in surgical techniques and therapeutics in the last decade, despite the use of a partial graft, which is often small-for-size, LDLT is at least as good as deceased donor liver transplantation (DDLT). Methods: We looked into the outcomes of DDLT, in low volume, by international standards, alongside a matured LDLT service. Comparison was made between our LDLT and overseas DDLT. Results: From 1991 to the end of 2007, we performed 185 DDLT (Era I, n=59, Era II, n=126). Era I coincided with the fi rst 50 LDLT in our center and was considered the formative period. All donors were brain-dead and heart-beating with a median age of 47.5 (range, 9 – 76 years). Up to 65.9% of recipients were hepatitis B carriers. Up to 29.7% were transplanted on high urgency basis and 14.6% for hepatocellular carcinoma. The Model for End-stage Liver Disease score was 21 (range, 6 – 56). Before transplantation, 15.7% were in the intensive care unit and 19.7% in hospital. Hospital mortality rate dropped from 13.6% (8/59) of Era I to 4.8% (6/126) of Era II (p =0.035). Recipient survival rates of Era I were 84.8%, 79.7%, and 76.3% and increased to 92.9%, 89.6%, and 88.0% at 1, 3, and 5 years (p = 0.0147). Only recipients underwent retransplantation (3.2%) and 1 failed. From Era II, recipient survivals surpassed the average 1- and 5-year survivals of DDLT by international standards. Conclusion: DDLT alongside LDLT has excellent results despite a small number.