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Living Donation Versus Donation After Circulatory Death Liver Transplantation for Low Model for End‐Stage Liver Disease Recipients
Author(s) -
Kling Catherine E.,
Perkins James D.,
Reyes Jorge D.,
Montenovo Martin I.
Publication year - 2019
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.25073
Subject(s) - medicine , liver transplantation , donation , liver disease , surgery , transplantation , model for end stage liver disease , retrospective cohort study , relative risk , organ donation , confidence interval , cohort study , economics , economic growth
In this era of organ scarcity, living donor liver transplantation (LDLT) is an alternative to using deceased donors, and in Western countries, it is more often used for recipients with low Model for End‐Stage Liver Disease (MELD) scores. 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. This is a retrospective cohort analysis of adult liver transplant recipients with a laboratory MELD of ≤20 who underwent transplantation between January 1, 2003 and March 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. There were 36,705 liver transplants performed: 32,255 (87.9%) from DBD donors, 2166 (5.9%) from DCD donors, and 2284 (6.2%) from living donors. In the mixed‐effects model, DCD status was associated with a higher risk of graft failure (relative risk [RR], 1.27; 95% confidence interval [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 a 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). In conclusion, for liver transplant recipients with low laboratory MELD, LDLT offers better graft survival and a tendency to better patient survival than DCD donors.