New study highlights the benefits of living donor liver transplant compared to a deceased donor

According to a new study conducted by the Thomas E. Starzl UPMC Transplant Institute and the University of Pittsburgh School of Medicine, living donor liver transplant offers many advantages over a deceased donor transplant, including improved patient survival at three years and lower costs.

The results, published online today in the Annals of surgery, highlighting living donation as a viable, if not preferable, option for the more than 14,000 people currently on the waiting list, as well as for many others who never qualify for the list under the rules current allocation.

According to the organ research and transplant network, approximately 8,000 liver transplants are performed each year, and live donor liver transplants account for less than 5% of this total. In addition, about 25% of people on the waiting list die every year while waiting for a transplant. In addition, those who end up with a transplant often have a long time on the waiting list, which affects their health at the time of the transplant.

"The consequences for patients on the waiting list can make the difference between life and death because the longer they wait, the sicker they become," said Abhinav Humar, MD, head of transplantation services at UPMC, clinical director of the Thomas E. Starzl Transplantation Institute and lead author of the study. "Living donor liver transplants, combined with deceased donor liver transplants, represent an opportunity to significantly reduce the risk of mortality on waiting list and allow us to graft a person faster."

The retrospective review of 245 live adult liver transplants and 592 deceased donor liver transplants performed in the last 10 years at UPMC – which has the largest living donor liver transplant program in the country – compared survival rates and other outcomes such as recovery times, complications, costs and resource utilization. Patients were followed for at least two years after the transplant.

Among these comparisons, the survival results of patients at three years were higher in liver transplant recipients living donors: 86% against 80%. Living donor liver transplant recipients overall had a survival advantage of about 5% compared to deceased recipients. Patients who received the liver from a living donor had an 11-day hospitalization versus 13 days for those who had received the liver from a deceased donor, were less likely to undergo an intraoperative blood transfusion (53% vs. 78%) and less post-transplant dialysis (1.6% versus 7.4%). Hospital costs related to transplantation were also 29.5% lower for living donors. For the living liver donor, no mortality was observed and the overall complication rate was 20%.

"The liver transplant of a living donor should be considered the first and the best option for most patients with liver disease," said Humar. "This is not just an option for people on the waiting list, but could possibly offset the fact that anyone who could benefit from a transplant is not eligible to receive a transplant from a deceased donor on the basis of the current allocation rules in effect. "

In view of its advantages, in recent years UPMC has expanded its living donor liver transplant program. In 2018, live donor transplants accounted for about 54% of the total number of liver transplants in the program, compared to the national average of about 4%. The UPMC transplant rate has also increased from 45 people on the program's waiting list in 2015 to around 88 in 2018. The program has led the country in living donor liver transplants during last two years and is the only center in the United States to have performed more live transplants than deceased donors.

"It's unclear why the number of live donor liver transplants is so low in the United States," said Amit Tevar, MD, badociate professor of surgery at Pitt's Department of Surgery and director of the kidney transplant program and of pancreas at the UPMC. "Fewer than 15 US programs have performed more than 10 live donor liver transplants in 2018, which is surprising given the number of national badyzes conducted in this country."