According to a new study in the October issue of Hepatology, a journal published by Wiley-Blackwell on behalf of the American Association of the Study of Liver Diseases, patients listed for liver transplantation who do not have cancer of the liver (hepatocellular carcinoma (HCC)) have a greater survival chance from a living donor liver transplant (LDLT), compared to those waiting for a deceased donor liver transplant (DDLT). The investigation reports that survival benefit from LDLT continues to be considerable across the range of model for end-stage liver disease (MELD) scores. However, this benefit was not noticeable among individuals with liver cancer and low MELD who received a live transplant.
Severity can range from mild to life-threatening liver failure for liver diseases, such as hepatitis B and C, nonalcoholic fatty liver disease, and HCC. Liver transplantation is the recommended procedure when a patient’s life is at risk from end-stage liver disease. According to the Organ Procurement and Transplant Network (OPTN), since September 2011 over 16,000 individuals in the U.S. are on the waiting list for a liver transplant. The OPTN reported that 3,108 liver transplants were performed in the U.S. between January and June 2011, with roughly 96% being DDLTs and 4% LDLTs.
Prior investigations discovered evidence that LDLT is connected with improved survival in comparison with waiting for DDLT, however, it is still unsure if this benefit persists in individuals with low MELD scores (less than 15). Chief author Carl Berg, M.D., with the University of Virginia Health System, said: “In order to better inform liver transplant candidates of survival outcomes, our study investigated the mortality risk of undergoing transplantation using livers from living donors versus waiting to receive a deceased donor organ.”
For the current investigation, data on individuals listed for liver transplant as well as potential donors were supplied by transplant centers that were involved in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study. The study included 868 adults who were listed for liver transplantation and were on average followed for 4.6 years. Living donors of the investigation participants were examined between February 2002 and August 2009 – the period following MELD-based liver allocation. Individuals who received DDLT at study centers were obtained for comparison during the same time period.
Mortality was compared between individuals who received LDLT and those who were still on the waiting list or who had received DDLT, with categories of MELD score lower or greater than 15, and liver cancer diagnosis. They discovered that 453 of the potential LDLT recipients had MELD scores lower than 15 and 415 had scores higher than 15. 712 of the participants received liver transplantation (406 LDLT – 306 DDLT), 83 participants died without transplant, and 73 still had not received a transplant at the final follow-up.
Dr. Berg. concluded: “We found that survival was significantly higher for candidates without HCC who underwent LDLT, rather than waiting for DDLT.” Results of the investigation revealed that those who had received a LDLT had a 56% lower mortality rate, and among those without HCC the mortality benefit was observed in both patients groups – those with MELD scores higher and lower than 15. However, they did not see a similar survival advantage for individuals with liver cancer who had MELD scores less than 15.
In her article also published in this month’s issue of Hepatology, Julie Heimbach, M.D., an Associate Professor of Surgery with the Mayo Clinic College of Medicine in Minnesota, explained:
“Dr. Berg and colleagues have provided very valuable new insights that will help answer the important question of optimal time to transplant. However, this study group was comprised of candidates who were deemed appropriate for LDLT and was not a randomized trial. Future studies validating quality of life outcomes following LDLT compared to prolonged wait listing or DDLT would assist physicians in advising patients and families in timing of and donor options for liver transplantation.”
Written by Grace Rattue