Living donor liver transplantation improves survival over deceased donor transplants
New research shows liver transplantation candidates without hepatocellular carcinoma (HCC) derive a greater survival benefit from a living donor liver transplant (LDLT) than waiting for a deceased donor liver transplant (DDLT). The study now available in the October issue of Hepatology, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases, reports that survival benefit from LDLT remains significant across the range of model for end-stage liver disease (MELD) scores, but this benefit was not apparent for low MELD candidates with HCC.
Liver diseases such as hepatitis B and C, nonalcoholic fatty liver disease, and HCC can range in severity from mild to life-threatening liver failure. In end-stage liver disease, when patient life is at risk, transplantation is the recommended option. According to the Organ Procurement and Transplant Network (OPTN), as of September 2011 more than 16,000 Americans are on the waiting list to receive a liver. Between January and June 2011 OPTN reported 3108 liver transplants were performed in the U.S., with roughly 96% being DDLTs and 4% LDLTs.
Previous studies found receipt of LDLT to be associated with improved survival compared with waiting for DDLT, however it remains unclear whether this advantage persists in candidates with low MELD scores (less than 15). "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," explains lead author Carl Berg, M.D., with the University of Virginia Health System.
For the present study, data on liver transplant candidates and potential donors were supplied by transplant centers involved in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study. A total of 868 adult liver transplant candidates were included in the study and were followed for a mean of 4.6 years. Living donors of the study candidates were evaluated between February 2002 and August 2009the period following MELD-based liver allocation. DDLT recipients transplanted at study centers were obtained for comparison during the same time period.
Mortality for LDLT recipients was compared to mortality of candidates remaining on the waiting list or who received DDLT, with categories of MELD score lower or greater than 15, and HCC diagnosis. Researchers reported that of the potential LDLT recipients, 453 had MELD scores lower than 15 and 415 were greater than 15. Transplantation was performed on 712 candidates (406 LDLT; 306 DDLT), 83 died without transplant, and 73 remained without transplant at the final follow-up.
"We found that survival was significantly higher for candidates without HCC who underwent LDLT, rather than waiting for DDLT," concluded Dr. Berg. Results showed that LDLT recipients had a 56% lower mortality rate, and among candidates without HCC the mortality benefit was seen in both patients groupsthose with MELD scores above and below 15. However, researchers did not observe a similar survival benefit for candidates with HCC who had MELD scores lower than 15.
"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," said Julie Heimbach, M.D., an Associate Professor of Surgery with the Mayo Clinic College of Medicine in Minnesota, in her editorial also published in this month's issue of Hepatology. "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."
More information: "Liver Transplant Recipient Survival Benefit with Living Donation in the MELD Allocation Era." Carl L. Berg, Robert M. Merion, Tempie H. Shearon, Kim M. Olthoff, Robert S. Brown Jr., Talia B. Baker, Gregory T. Everson, Johnny C. Hong, Norah Terrault, Paul H. Hayashi, Robert A. Fisher, James E. Everhart. Hepatology; Published Online: June 17, 2011 (DOI: 10.1002/hep.24494); Print Issue Date: October 2011.
Editorial: "The Benefit of Living Donor Liver Transplantation: Who and When?" Julie K. Heimbach and Russell H. Wiesner. Hepatology; Published Online: July 28, 2011 (DOI: 10.1002/hep.24578); Print Issue Date: October 2011.
Provided by Wiley
- Living donor liver transplants may drastically decrease mortality from liver failure Sep 04, 2008 | not rated yet | 0
- Changes to distribution of livers for transplant proposed Sep 09, 2011 | not rated yet | 0
- Lower tacrolimus doses is suitable for living donor liver transplantation with small-for-size graft Aug 26, 2009 | not rated yet | 0
- Liver transplant offers survival benefits for patients of all sizes Dec 04, 2007 | not rated yet | 0
- Liver donations from living donors increase 42 percent after educational intervention Jan 07, 2010 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
High blood glucose is associated with poor outcomes in hospitalized patients, and use of intensive insulin therapy (IIT) to control hyperglycemia is a common practice in hospitals. But the recent evidence does not show a ...
Other May 24, 2013 | 4 / 5 (1) | 0
Two out of five medical students have an unconscious bias against obese people, according to a new study by researchers at Wake Forest Baptist Medical Center. The study is published online ahead of print in the Journal of ...
Other May 23, 2013 | not rated yet | 0
Nanyang Technological University's (NTU) new medical school will be pioneering the use of plastinated bodies for medical education in Singapore.
Other May 23, 2013 | not rated yet | 0
A 2012 survey of internal medicine residents at Massachusetts General Hospital (MGH) – one of the nation's leading teaching hospitals – found that more than half rated the training they had received in addiction and other ...
Other May 22, 2013 | 5 / 5 (1) | 0
Early use of tracheostomy for mechanically ventilated patients not associated with improved survival
For critically ill patients receiving mechanical ventilation, early tracheostomy (within the first 4 days after admission) was not associated with an improvement in the risk of death within 30 days compared to patients who ...
Other May 21, 2013 | not rated yet | 0
Coenzyme Q10 decreases all cause mortality by half, according to the results of a multicentre randomised double blind trial presented today at Heart Failure 2013 congress. It is the first drug to improve heart failure mortality ...
15 hours ago | 5 / 5 (2) | 5
(HealthDay)—Animals make great companions for senior citizens, but elderly people who always drive with a pet in the car are far more likely to crash than those who never drive with a pet, researchers have ...
7 hours ago | not rated yet | 1
Heart failure accelerates the aging process and brings on early andropausal syndrome (AS), according to research presented today at the Heart Failure Congress 2013. AS, also referred to as male 'menopause', was four times ...
15 hours ago | not rated yet | 1
Mortality and length of stay are highest in heart failure patients admitted in January, on Friday, and overnight, according to research presented today at the Heart Failure Congress 2013. The analysis of nearly 1 million ...
15 hours ago | not rated yet | 0
(AP)—Department of Justice lawyers have again asked a federal appeals court in New York to delay lifting age restrictions and prescription requirements on an emergency contraceptive popularly known as the morning-after ...
15 hours ago | not rated yet | 0