title: Adult living donor versus deceased donor liver transplantation: a 10-year prospective single center experience.
abstract: It has been 4 years since the first, long-term (> 3 years) prospective comparison of adult-to-adult living donor liver transplantation (A2ALLTx) to adult deceased donor liver transplantation (ADDLTx) was reported. In this follow up, prospective, IRB approved, 10-year comparison of A2ALLTx to ADDLTx we expand on our initial observations. This data includes: age, gender, ethnicity, primary liver disease, waiting time, pretransplant CTP/MELD score, cold ischemia time (CIT), perioperative mortality, acute and chronic rejection, graft and patient survival, charges and post-transplant complications. In 10 years, 465 ADDLTx (81.3%) and 107 A2ALLTx (18.7%) were performed at VCUHS. Hepatitis C virus (HCV) was the most common reason for transplantation in both groups (54.5% vs. 48.2%). Data regarding overall patient and graft survival and retransplantation rates were similar. Comparison of patient/graft survivals, retransplantation rates in patients with and without HCV were not statistically different. A2ALLTx patients had less acute rejection (9.6% vs. 21.7%) and more biliary complications (27.1% vs. 17.6%). In conclusion, A2ALLTx is as durable a liver replacement technique as the ADDLTx. Patients with A2ALLTx were younger, had lower MELD scores, less acute rejection and similar histological HCV recurrence. Biliary complications were more common in A2ALLTx but were not associated with increased graft loss compared to ADDLTx.
authors.affiliation: Division of Transplantation, Department of Surgery, Virginia Commonwealth, University Health System, Richmond, VA, USA. rafisher@vcu.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
authors.forename: Adrian H
authors.initials: AH
authors.lastname: Cotterell
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Maluf
authors.forename: Richard Todd
authors.initials: RT
authors.lastname: Stravitz
authors.forename: April
authors.initials: A
authors.lastname: Ashworth
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Nakatsuka
authors.forename: Richard K
authors.initials: RK
authors.lastname: Sterling
authors.forename: Velimir A
authors.initials: VA
authors.lastname: Luketic
authors.forename: Martha K
authors.initials: MK
authors.lastname: Behnke
authors.forename: Marc P
authors.initials: MP
authors.lastname: Posner
mesh_terms: D000328:Adult; D050377:Cold Ischemia; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006526:Hepatitis C / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D019520:Living Donors; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D007166:Immunosuppressive Agents