The study provides support for the increasing use of living donor liver transplants in Western countries

The study provides support for the increasing use of living donor liver transplants in Western countries

Demand for donor livers for transplant patients exceeds supply, with over 15% of patients on the waiting list dying after one year. A new international study supports increasing the use of living donor liver transplants (LDLT) in Western countries and reducing the imbalance between organ supply and demand. This study is reported in the Journal of Hepatology, the official journal of the European Association for the Study of the Liver, published by Elsevier.

In LDLT, part of the liver is removed from a healthy person and inserted into a person whose liver is no longer functioning properly. The donor's remaining liver grows back and returns to its normal size, volume and capacity within a few months after surgery. Although the waiting time for a deceased donor transplant can be more than five years, LDLT remains rare compared to deceased donor liver transplant (DDLT) in Western countries compared to those in Asia.

Identifying differences in outcomes and other transplant characteristics may help identify areas for health care improvement and clarify whether expansion of LDLT practices may be warranted in countries that rely primarily on DDLT.

There is growing interest in strategies to alleviate the increasing demand for transplantation and the unacceptably high mortality on the liver transplant waiting list. One such approach is LDLT, which can increase the number of grafts available for transplantation. However, short- and long-term outcomes must be maintained for both donors and recipients. We therefore sought to compare donor and recipient characteristics as well as post-transplant outcomes after LDLT.”

Gonzalo Sapisochin, MD, PhD, MSc, Department of General Surgery, University Health Network, Toronto, ON, Canada

This is a retrospective multicenter study of adults aged 18 years and older who underwent primary LDLT between January 2008 and December 2018, as reported by three national liver transplant registries: United Network for Organ Sharing (UNOS; USA), National Health Service Blood and Transplantation (NHSBT; UK), and the Canadian Organ Replacement Registry (CORR; Canada). Patients who underwent retransplantation or multiorgan transplantation were excluded. Researchers compared recipient and donor characteristics, temporal trends, and post-LDLT outcomes across the three registries. In addition, they sought to assess the outcomes for LDLT compared to DDLT in each of the countries.

A total of 2,954 LDLTs were performed in these countries, including 2,328 in the United States, 529 in Canada, and 97 in the United Kingdom. Canada performed the highest proportion of LDLT procedures over time. Researchers were pleasantly surprised to see that long-term results were excellent despite the relatively low use of LDLT in Western countries. One-, five-, and 10-year patient survival rates in the United States were 92.6%, 82.8%, and 70.0%; 96.1%, 89.9% and 82.2% in Canada; and 91.4%, 85.4% and 66.7% in the United Kingdom, respectively.

This analysis of LDLT shows that despite the low use of LDLT in Western countries compared to Asian countries, long-term survival is excellent. Furthermore, the mortality risk is not statistically significantly different between these three countries.

“This study supports the increasing use of LDLT in Western countries as it provides an opportunity to reduce the imbalance between organ supply and demand, thereby offering waiting list candidates the opportunity for earlier transplantation and lower mortality on the transplant waiting list.” “ commented Dr. Sapisochin

Source:

Otherwise

Reference:

Ivanics, T., et al. (2022) Low use of LDLT among adults in Western countries despite excellent results: International multicenter analysis of the US, UK and Canada. Journal of Hepatology. doi.org/10.1016/j.jhep.2022.07.035.