SMALL VOLUME DECEASED DONOR LIVER TRANSPLANTATION ALONGSIDE LIVING DONOR LIVER TRANSPLANTATION

Abstract

Living donor liver transplantation (LDLT) is to date the only realistic life-saving treatment alternative to deceased donor liver transplantation. With advances in surgical techniques and therapeutics in the last decade, despite the use of a partial graft, which is often small-for-size, LDLT is at least as good as deceased donor liver transplantation (DDLT). We looked into the outcomes of DDLT, in small volume, by international standards, alongside a matured LDLT service. Comparison was made between our LDLT and overseas DDLT. From 1991 to the end of 2007, we performed 185 DDLT (Era I, n = 59, Era II, n = 126). Era I coincided with the first 50 LDLT in our center and was considered the formative period. All donors were brain-dead and heart-beating with a median age of 47.5 (range, 9–76 years). Up to 65.9% of recipients were hepatitis B carriers. Up to 29.7% were transplanted on high urgency basis and 14.6% for hepatocellular carcinoma. The Model for End-stage Liver Disease score was 21 (range, 6–56). Before transplantation, 15.7% were in the intensive care unit and 19.7% in hospital. Hospital mortality rate dropped from 13.6% (8/59) of Era I to 4.8% (6/126) of Era II (P = 0.035). Recipient survival rates of Era I were 84.8, 79.7, and 76.3% and increased to 92.9, 89.6, and 88.0% at 1, 3, and 5 years (P = 0.0147). Only six recipients underwent retransplantation (3.2%) and one failed. From Era II, recipient survivals surpassed the average 1- and 5-year survivals of DDLT by international standards. DDLT alongside LDLT has excellent results despite a small number.