For years, research data gathered from nationwide studies provided evidence that liver transplant recipients had an improved chance of survival when they received a liver from a deceased donor compared to a live-donor liver. But a new study from Perelman School of Medicine at the University of Pennsylvania suggests that's just not so. In fact, the researchers report that living-donor transplants can actually offer superior outcomes compared to livers from deceased donors.
For their study, the researchers reviewed 10 years of national transplant data from the Organ Procurement and Transplant Network (OPTN) that was gathered between 2002 and 2012, evaluating and comparing three-year and five-year outcomes data for both deceased donor transplant recipients and those who received living donor transplants. The records included data for 2,103 living donor transplant recipients and 46,674 people who received deceased donor transplants.
Comparing the two groups of patients, the researchers found that those who received livers from deceased donors had a three-year survival rate of 78 percent, while the three-year survival rate for live-donor recipients was 83 percent. Looking at five-year survival data, the gap was even more pronounced: 71 percent for deceased-donor transplant recipients, compared to 78 percent among recipients of live-donor livers.
Two key factors for better survival
The study authors noted the higher survival rates among living-donor transplant recipients appeared to be related to two key factors: the use of appropriate donor selection and the choice of an experienced transplant center to perform the surgery. The researchers defined an experienced center as one that had performed at least 15 adult-to-adult living-donor liver transplants.
The study also reported that patients with complications due to autoimmune hepatitis or cholestatic liver disease and who received a living-donor liver at an experienced transplant center had higher survival benefits compared to those who received a deceased-donor transplant.
For years, livers from deceased donors have been preferred by most physicians, due largely to the data that suggested deceased-donor transplants were associated with better outcomes. As a result, waiting lists for deceased-donor liver transplants have grown to tremendous lengths, creating a life-threatening backlog and significantly increasing wait-list mortality rates.
The researchers say they hope this study will help reassure physicians who may be concerned about survival rates with live-donor livers and also encourage the use of live donors so more people can receive donor livers faster. Currently, there are 36 centers in the U.S. that perform living-donor liver transplant procedures. Sixteen centers, including Penn, have performed more than 60 of the procedures since 2002.
New scoring system
In addition to these results, the researchers designed a novel scoring system to help predict post-transplant outcomes in living-donor transplant recipients. The scoring system looks at several donor and recipient variables to achieve a final value, dividing transplant recipients into high-risk, intermediate-risk and low-risk groups.
Although the system remains to be validated, the researchers said they hope it eventually will help facilitate better matches between donors and recipients to achieve better outcomes, as well as providing more objective criteria by which donors may be selected. The scoring system may also serve as a valuable tool for helping patients understand the potential benefits of specific transplant scenarios, the researchers said.
