3 years ago

Living Donation Versus Donation After Circulatory Death Liver Transplantation for Low MELD Recipients

James D Perkins, Catherine E Kling, Jorge D Reyes, Martin I Montenovo

ABSTRACT

Background

In this era of organ scarcity, living donor liver transplant (LDLT) is an alternative to using deceased donors and in Western countries is more often used in low model for end‐stage liver disease (MELD) recipients. We sought to compare the patient survival and graft survival between recipients of liver transplantation from living donors and donation after circulatory death (DCD) donors in patients with low MELD scores.

Methods

Retrospective cohort analysis of adult liver transplant recipients with a laboratory MELD <= 20 who underwent transplantation between 01/01/2003 and 03/31/2016. Recipients were categorized by donor graft type (DCD or LDLT) and recipient and donor characteristics were compared. Ten‐year patient and graft survival curves were calculated using Kaplan‐Meier analyses and a mixed‐effects model was performed to determine the contributions of recipient, donor and center variables on patient and graft survival.

Results

36,705 liver transplants were performed – 2,166 (5.9%) were from DCD donors and 2,284 (6.2%) from living donors. In the mixed‐effects model, DCD status was associated with a higher risk of graft failure (RR 1.27, 95% CI 1.16‐1.38) but not worse patient survival (RR 1.27, 95% CI: 0.96‐1.67). Lower DCD center experience was associated with a 1.21 higher risk of patient death (95% CI: 1.17‐1.25) and 1.13 higher risk of graft failure (95% CI: 1.12‐1.15). LDLT center experience was also predictive of patient survival (RR 1.03, 95% CI: 1.02‐1.03) and graft failure (RR 1.05, 95% CI: 1.05‐1.06).

Conclusion

For liver transplant recipients with low laboratory MELD, LDLT offers better graft survival and a tendency to better patient survival than DCD donors. This article is protected by copyright. All rights reserved.

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