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Clinical significance and outcomes of adult living donor liver transplantation for acute liver failure: a retrospective cohort study based on 15-year single-center experience

Summary

Researchers studied 267 patients with acute liver failure over 15 years to compare two types of liver transplants: using living donors versus deceased donors. Living donor transplants worked just as well as deceased donor transplants, with similar patient survival rates, but allowed faster surgery before patients became critically ill. When a suitable living donor was available, performing the transplant quickly before severe brain complications developed led to better patient outcomes.

Background

Acute liver failure (ALF) is a rare but life-threatening condition requiring immediate liver transplantation. In Asian countries with limited deceased donor availability, living donor liver transplantation (LDLT) serves as an alternative to deceased donor liver transplantation (DDLT). However, concerns remain about recipient outcomes and donor safety in the emergency setting.

Objective

This study aimed to evaluate the safety and efficacy of LDLT for ALF by comparing surgical and survival outcomes with DDLT, and to identify factors associated with survival after liver transplantation for ALF.

Results

LDLT demonstrated comparable outcomes to DDLT with 10-year overall survival of 90.8% vs 84.0% (P=0.096) and graft survival of 83.5% vs 71.3% (P=0.051). In-hospital mortality was not significantly different (11.8% vs 14.2%, P=0.435). LDLT patients had shorter ICU stay (5.0 vs 9.5 days, P<0.001) but higher surgical complication rate (41.6% vs 28.3%, P=0.009). Vasopressor use and brain edema were independent predictors of in-hospital mortality.

Conclusion

LDLT is a feasible and effective treatment for ALF with outcomes comparable to DDLT. When living donors are available, prompt LDLT before brain edema development can positively impact patient survival, making it a valuable alternative when deceased donors are unavailable.
  • Published in:Annals of Surgical Treatment and Research,
  • Study Type:Retrospective Cohort Study,
  • Source: PMID: 39282101, DOI: 10.4174/astr.2024.107.3.167
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