A new international study has offered insight into resolving the imbalance between organ supply and demand, which is costing the lives of liver transplant patients.
There are two forms of liver transplant, living donor liver transplant (LDLT) and deceased donor liver transplant (DDLT). In an LDLT, a portion of the liver from a healthy person is removed and placed into the patient. The remaining liver of the donor will regrow and return to its previous size, volume, and capacity over a few months. LDLT is uncommon in western countries when compared to Asia. Yet, the waiting period for a DDLT can be over five years.
This study had been published in the Journal of Hepatology, the official journal of the European Association for the Study of the Liver, by Elsevier.
The number of liver transplant donors is too low
Demand for liver donors outweighs supply, meaning over 15% of people on the waitlist die within a year.
Understanding differences in outcomes and other transplant characteristics may help identify ways to improve healthcare for liver transplant patients. This study sought to clarify whether expanding LDLT practices could be justified in countries that primarily rely on DDLT.
“There has been a growing interest in strategies to alleviate the increasing demand for transplantation and the unacceptably high mortality on the liver transplant waitlist,” explained Gonzalo Sapisochin, MD, PhD, MSc, Division of General Surgery, University Health Network, Toronto, Canada.
“One such approach is LDLT, which can expand the number of grafts available for transplantation. However, short- and long-term outcomes need to be maintained for both the donors and recipients. We, therefore, sought to compare donor and recipient characteristics and post-transplant outcomes after LDLT.”
The study analysed data from adults aged 18 or older who underwent primary LDLT between January 2008 and December 2018 across multiple different healthcare centres. The data was taken from the United Network for Organ Sharing (UNOS; US), National Health Service Blood and Transplantation (NHSBT; UK), and the Canadian Organ Replacement Registry (CORR; Canada). Patients undergoing retransplantation or multi-organ transplantation were not included in the study.
The researchers compared the donor and recipient characteristics, temporal trends and post-LDLT outcomes across the three registries. The researchers also evaluated outcomes for LDLT compared to DDLT within each country.
Living donors yielded positive results
Across all three countries, a total of 2,954 LDLTs were performed. Of these, 2,328 took place in the US, 529 in Canada, and 97 in the UK. Canada had the highest proportion of LDLT procedures over the study period. The researchers found that the long-term outcomes for LDLT were excellent relatively low use in Western countries.
The one-, five-, and ten-year patient survival rates were 92.6%, 82.8%, and 70.0% in the USA; 96.1%, 89.9%, and 82.2% in Canada; and 91.4%, 85.4%, and 66.7% in the UK, respectively.
These figures demonstrate that despite the low use of living donors in Western Countries, the long-term survival rates make it a better option for liver transplant patients. It is important to note that the statistics surrounding mortality risk did not differ significantly between each country.
“This study offers support for increasing the use of LDLT in Western countries because it provides an opportunity to reduce the imbalance between organ supply and demand and, as a result, offers waitlist candidates the possibility of earlier transplantation and decreased mortality on the liver transplant waitlist,” concluded Dr Sapisochin.