viable option and should be considered for the over 14,000 patients currently
on the waiting list and many others who are ineligible to be on the list under
current policy regulations.
to Abhinav Humar, M.D., chief of transplant services at UPMC, lead author of
the study and clinical director of the transplantation institute, "Living-donor liver
transplants, in tandem with deceased-donor liver transplants, represents an opportunity to significantly
decrease the risk of wait-list mortality, and gives us the
ability to transplant a person sooner."
Outcomes of Live Vs.
Deceased Donor Liver Transplant
current retrospective study analyzed 245 adult
live donor liver transplants and 592 deceased-donor liver transplants done at
the UPMC over the last 10 years
to compare survival rates and other patient
outcomes such as complications, costs, recovery duration and utilization of
resources. The patients were
monitored for at least two years following transplant. UPMC has the
biggest live-donor liver transplant program in the US.
The key findings of the study included
- Three-year patient survival rates in
live-donor liver transplant recipients were 86%
versus 80% for deceased donor liver recipients
- Recipients of living-donor
liver transplant overall had about a 5% improved survival compared to
recipients of liver from deceased-donor
- Recipients of live donor liver
transplant had a hospital stay of 11 days in comparison to 13 days for
recipients of deceased donor liver transplant
donor recipients were less likely to need intraoperative blood transfusion
compared to deceased donor recipients (53% compared to 78%) and less
likely to need post-transplant dialysis (1.6% and 7.4% respectively)
- Hospital expenses for living-donor
liver transplants were found to be 29.5%
lesser compared to deceased donor recipients
- No mortalities were observed, and
the overall complication rate in living donors was found to be 20%
The findings of the study suggest that living-donor liver
transplant could potentially improve survival rates and reduce
thousands of patients with liver failure needing a transplant.
liver transplant should be considered the first and best option for most
patients with liver disease,"
Humar said. "It is not only an
option for those on the waiting list but could perhaps offset the fact that not
everyone who may benefit from transplant qualifies to receive a deceased-donor
transplant based on today's current rules of allocation."
of Live Donor Liver Transplants in UPMC
has the distinction of leading the country in live donor liver transplants in the last two years
and is the only center in the U.S.
to have done more live than
deceased donor liver transplants.
- In 2018, living-donor
transplants done in UPMC was 54% compared to 4%,
which is the US national average
- UPMC's transplant
rate also rose from 45 out of every 100 persons on the program's waiting
list in 2015 to almost 88 in 2018
Living-donor Liver Transplant
In a living-donor
liver transplant, a portion of the liver from a healthy living
donor is removed surgically and transplanted into a recipient after surgically
removing his diseased liver. The donor's
grows back to its original size within a short period, latest by eight weeks.
This allows more persons to become liver donors.
Donor eligibility criteria
- 18-60 years of age
- Must not be pregnant
- Should not be obese or overweight
- No underlying medical conditions or mental illness.
- Should be a non-smoker or stop smoking for at least 6 weeks prior to surgery
- Should agree to follow
doctor's instructions prior to and after surgery
- Should be same blood type as the recipient, but need not be blood relative
The reasons for low rates of living-donor liver transplant include ethical concerns of potential complications in the donor following surgery for the benefit of someone else and immunological factors that may influence transplant outcome.
It is suggested that the decision to use a live or deceased donor should depend on the patient's status, availability of suitable match, and level of expertise of the center performing the procedure.
In summary, live donor liver transplants could be a way forward to improve survival and offer a ray of hope and make a huge difference for the hundreds of families who have a patient needing a liver transplant.References :
- New Study Highlights Advantages of Living-Liver Donation - (https://www.upmc.com/media/news/071219-ldlt-ddlt-paper)
- Living Donor Liver Transplant - (https://transplant.surgery.ucsf.edu/conditions--procedures/living-donor-liver-transplant.aspx)