Living donor and deceased donor liver transplantation for autoimmune and cholestatic liver diseases--an analysis of the UNOS database.
BACKGROUND
Autoimmune hepatitis and cholestatic liver diseases have more favorable outcomes after liver transplantation as compared to viral hepatitis and alcoholic liver diseases. However, there are only few reports comparing outcomes of both living donor liver transplants (LDLT) and deceased donor liver transplants (DDLT) for these conditions.


OBJECTIVE
We aim to study the survival outcomes of patients undergoing LT for autoimmune and cholestatic diseases and to identify possible risk factors influencing survival. Survival outcomes for LDLT vs. DDLT are also to be compared for these diseases.


METHODS
A retrospective analysis of the UNOS database for patients transplanted between February 2002 until October 2006 for AIH, PSC, and PBC was performed. Survival outcomes for LDLT and DDLT patients were analyzed and factors influencing survival were identified.


RESULTS
Among all recipients the estimated patient survival at 1, 3, and 5 years for LDLT was 95.5%, 93.6%,and 92.5% and for DDLT was 90.9%, 86.5%, and 84.9%, respectively (p = 0.002). The estimated graft survival at 1, 3, and 5 years for LDLT was 87.9%, 85.4%, and 84.3% and for DDLT 85.9%, 80.3%, and 78.6%, respectively (p = 0.123). On multivariate proportional hazard regression analysis after adjusting for age and MELD score, the effect of donor type was not found to be significant.


CONCLUSIONS
The overall survival outcomes of LDLT were similar to DDLT in our patients with autoimmune and cholestatic liver diseases. It appears from our study that after adjusting for age and MELD score donor type does not significantly affect the outcome.
Kashyap
Randeep
R
Department of Surgery, Division of Solid Organ Transplantation, University of Rochester Medical Center, P.O. Box SURG, 601 Elmwood Avenue, Rochester, NY 14642, USA. randeep_kashyap@urmc.rochester.edu
Safadjou
Saman
S
Chen
Rui
R
Mantry
Parvez
P
Sharma
Rajeev
R
Patil
Vrishali
V
Maloo
Manoj
M
Ryan
Charlotte
C
Marroquin
Carlos
C
Barry
Christopher
C
Ramaraju
Gopal
G
Maliakkal
Benedict
B
Orloff
Mark
M
D000328:Adult; D015209:Cholangitis, Sclerosing / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D019693:Hepatitis, Autoimmune / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology