title: Living donor versus deceased donor liver transplantation: a surgeon-matched comparison of recipient morbidity and outcomes.
abstract: Informed consent for living donor liver transplantation (LDLT) requires that patients are provided with accurate information on the relative benefits and risks of this procedure compared with deceased donor liver transplantation (DDLT). There is strong evidence to suggest that LDLT facilitates timely transplantation to patients; however, information on the relative morbidity and death risks after LDLT as compared with DDLT is limited. A matched cohort comparison was performed matching recipients for age, MELD, date of transplant, gender, primary diagnosis, and recipient surgeon. A total of 145 LDLT were matched with 145 DDLT. LDLT had a higher overall rate of perioperative surgical complications (P = 0.009). Most of this difference was caused by a higher rate of biliary complications. However, the complications that occurred in the DDLT group tended to be more serious (P = 0.037), and these complications were strongly associated with graft loss in multivariate analysis. The 3- and 5-year graft and patient survivals were similar. In conclusion, DDLT and LDLT have different complication profiles, but comparable hospital stays and survival rates. In areas of deceased donor organ shortages, LDLT offers an excellent alternative to DDLT because it facilitates access to a liver transplant without compromising short- or medium-term recipient outcomes.
authors.affiliation: Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. treichman@ochsner.org
authors.forename: Trevor W
authors.initials: TW
authors.lastname: Reichman
authors.forename: Helena
authors.initials: H
authors.lastname: Katchman
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Tanaka
authors.forename: Paul D
authors.initials: PD
authors.lastname: Greig
authors.forename: Ian D
authors.initials: ID
authors.lastname: McGilvray
authors.forename: Mark S
authors.initials: MS
authors.lastname: Cattral
authors.forename: Eberhard L
authors.initials: EL
authors.lastname: Renner
authors.forename: Markus
authors.initials: M
authors.lastname: Selzner
authors.forename: Anand
authors.initials: A
authors.lastname: Ghanekar
authors.forename: Gary
authors.initials: G
authors.lastname: Levy
authors.forename: David R
authors.initials: DR
authors.lastname: Grant
mesh_terms: D000328:Adult; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: deceased donation; graft survival; liver transplantation; living donation; perioperative complications