NEW YORK — In adults needing a new liver, transplanting a portion of a liver donated from a living donor works just as well as transplanting an entire organ donated from a deceased person, according to a study of liver transplants performed at a hospital in Hong Kong.
The only difference that doctors observed was a higher incidence of abnormal narrowing of the bile ducts associated with partial transplants, but this complication was amenable to treatment and did not affect survival of the graft or patient.
Retrospective studies have suggested that graft survival with so-called “right lobe live donor liver transplantation” was inferior to cadaveric liver transplantation, which was blamed on small graft size. However, Dr. Sheung Tat Fan and others at the University of Hong Kong point out that a prospective comparison of the two procedures within a single center has not been reported.
They therefore compared outcomes for adults treated between 2000 and 2004 at Queen Mary Hospital. Included were 124 patients who underwent right lobe live donor liver transplantation and 56 who underwent cadaveric whole-graft liver transplantation.
According to the team, there were no marked differences between the two groups in terms of length of hospital or ICU stay or deaths occurring before hospital discharge.
After a median follow-up of 27 months in the living donor group and 25 months in the cadaver donor group, corresponding patient survival was 90 percent and 84 percent. During the same period, the mortality rate of patients on the wait list was 43 percent.
Not surprisingly, preop waiting times were much shorter for partial live liver transplants as opposed to cadaveric whole-organ transplants — 14 days versus 237 days, the investigators report in the Annals of Surgery.
As noted, the only significant difference between groups was the incidence of bile duct narrowing — 25 percent in the living donor group and 5 percent in the cadaveric donor group. This complication was treated successfully with a variety of techniques including stenting.
Fan’s team also points out that none of the individuals who donated part of their liver died or required any transfusions and complications in the live donors that did arise were successfully managed.
This study, the authors conclude, do not support past studies that have suggested that partial live donor liver transplantation is less effective than cadaveric whole-organ liver transplantation. Partial liver grafts “should not be considered as marginal grafts,” they conclude.
SOURCE: Annals of Surgery March 2006.
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