Adult-to-adult living donor liver transplantation in acute liver failure

Alexandra Shingina; Ioannis A Ziogas; Philip Vutien; Elizabeth Uleryk; Prakesh S Shah; Eberhard Renner; Mamatha Bhat; Jill Tinmouth; Joseph Kim

doi:10.1016/j.trre.2022.100691

Adult-to-adult living donor liver transplantation in acute liver failure

Transplant Rev (Orlando). 2022 Apr;36(2):100691. doi: 10.1016/j.trre.2022.100691. Epub 2022 Mar 22.

Authors

Alexandra Shingina¹, Ioannis A Ziogas², Philip Vutien³, Elizabeth Uleryk⁴, Prakesh S Shah⁵, Eberhard Renner⁶, Mamatha Bhat⁷, Jill Tinmouth⁸, Joseph Kim⁹

Affiliations

¹ Vanderbilt University Medical Center, Faculty of Medicine, Department of Gastroenterology, Hepatology and Nutrition, United States of America. Electronic address: Alexandra.shingina@vumc.org.
² Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN, United States of America.
³ University of Washington, Division of Gastroenterology and Hepatology, United States of America.
⁴ E.M. Uleryk Consulting, Mississauga, ON, Canada.
⁵ Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Canada.
⁶ University of Manitoba, Faculty of Medicine, Canada.
⁷ University of Toronto, Toronto General Hospital, Multiorgan Transplant, Canada.
⁸ Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Canada.
⁹ University of Toronto, Toronto General Hospital, Multiorgan Transplant, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Canada.

PMID: 35367836
DOI: 10.1016/j.trre.2022.100691

Abstract

Background: Living Donor Liver Transplantation(LDLT) in acute liver failure(ALF) patients has been limited by concerns regarding donor safety, consent process and recipient outcomes. Our objective was to conduct a systematic review(SR) and meta-analysis to address the concerns about subpar LDLT outcomes in patients with ALF.

Methods: We retrieved a total of 5965 literature references in our SR. United Network for Organ Sharing (UNOS) database was queried for patients over the age of 18, who underwent LDLT for "status 1" or "status 1A" listing.

Results: Of 427 articles reviewed, 3 studies comprising 2574 patients (192 underwent LDLT and 2382 DDLT), were included in the meta-analysis. One, 3,5-year patient and graft survival demonstrated no difference between LDLT and DDLT group: 1-year patient survival OR1.51; 95%CI [0.58,1.90]; 1-year graft survival OR 1.19; 95%CI [0.65-2.18]; 3-year patient survival OR 0.97;95%CI [0.52-1.88]; 3-year graft survival OR 1.21 95%CI [0.67-2.16]; 5-year patient survival 0.9; 95%CI [0.37-2.20]; 5-year graft survival OR 1.30; 95%CI [0.57-2.97]. UNOS database search returned only 3 patients that underwent LDLT for ALF compared to 1562 with DDLT, precluding comparison.

Conclusion: One, 3, and 5-year patient and graft survival following LDLT vs DDLT transplantation were not statistically significantly different; however, due to limited number of studies further studies are warranted.

Keywords: DDLT; Graft survival; LDLT; Live donor advantage; Liver graft; Posttransplant survival.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Adult
Graft Survival
Humans
Liver Failure, Acute* / surgery
Liver Transplantation*
Living Donors
Middle Aged
Treatment Outcome