Reduced mortality with right-lobe living donor compared to deceased-donor liver transplantation when analyzed from the time of listing.
Right lobe living donor liver transplantation (RLDLT) is not yet a fully accepted therapy for patients with end-stage liver failure in the Western hemisphere because of concerns about donor safety and inferior recipient outcomes. An outcome analysis from the time of listing for all adult patients who were listed for liver transplantation (LT) at our center was performed. From 2000 to 2006, 1091 patients were listed for LT. One hundred fifty-four patients (LRD; 14%) had suitable live donors and 153 (99%) underwent RLDLT. Of the remaining patients (DD/Waiting List; n = 937), 350 underwent deceased donor liver transplant (DDLT); 312 died or dropped off the waiting list; and 275 were still waiting at the time of this analysis. The LRD group had shorter mean waiting times (6.0 months vs. 9.8 months; p < 0.001). Although medical model for end-stage liver disease (MELD) scores were similar at the time of listing, MELD scores at LT were significantly higher in the DD/Waiting List group (15.4 vs. 19.5; p = 0.002). Patients in Group 1 had a survival advantage with RLDLT from the time of listing (1-year survival 90% vs. 80%; p < 0.001). To our knowledge, this is the first report to document a survival advantage at time of listing for RLDLT over DDLT.
Shah
S A
SA
Multi-Organ Transplant Unit, University Health Network, University of Toronto, Toronto, Canada.
Levy
G A
GA
Greig
P D
PD
Smith
R
R
McGilvray
I D
ID
Lilly
L B
LB
Girgrah
N
N
Cattral
M S
MS
Grant
D R
DR
D000328:Adult; D002102:Cadaver; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology*; D019520:Living Donors / Q000706:statistics & numerical data*; D018579:Patient Selection; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome; D014850:Waiting Lists