Impact of right-lobe live donor liver transplantation on patients waiting for liver transplantation

Abstract

Right-lobe live donor liver transplantation (LDLT) is accepted for adult patients, but the incremental benefit of LDLT over cadaveric donor liver transplantation (CDLT) is unknown. We evaluated prospectively the impact of right-lobe LDLT on patients listed for CDLT. Between January 1999 and December 2001, a total of 152 patients with chronic liver disease were listed for liver transplantation. The options of LDLT and CDLT were given after listing. Sixty-five patients (43%) had volunteers and 87 patients (57%) did not have volunteers. The groups with and without volunteers were similar in terms of age, diagnosis of liver disease, and Model for End-Stage Liver Disease score. The group with volunteers had a shorter waiting time for transplantation (median, 38 v 344 days; P < .001), greater transplantation rate (72% v 20%; P < .001), and lower mortality rate while waiting for a transplant (15% v 30%; P = .037). Overall, right-lobe LDLT was performed in 44 patients (29%). It increased the transplantation rate from 13% to 42%. On follow-up until December 2002 (median follow-up, 17.4 months), survival rates of the groups with and without volunteers were 68% and 51%, respectively (P = .034). One- and 3-year survival rates were 72.3% and 66.4% for the group with volunteers and 61.9% and 45.6% for the group without volunteers, respectively (P = .028). In conclusion, right-lobe LDLT offers patients listed for transplantation an incremental benefit by tripling the transplantation rate and improving overall survival.