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Is left lobe adult-to-adult living donor liver transplantation ready for widespread use? The US experience (1998–2010)

Authors


Reza F. Saidi, Division of Organ Transplantation, Department of Surgery, University of Massachusetts Medical School, 55 Lake Avenue North, S6-426, Worcester, MA 01655, USA. Tel: + 1 508 334 2023. Fax: + 1 508 856 1102. E-mail: reza.saidi@umassmemorial.org

Abstract

Objectives:  Living donor liver transplantation (LDLT) is an accepted treatment for patients with end-stage liver disease. To minimize risk to the donor, left lobe (LL) LDLT may be an ideal option in adult LDLT.

Methods:  This study assessed the outcomes of LL-LDLT compared with right lobe (RL) LDLT in adults (1998–2010) as reported to the United Network for Organ Sharing (UNOS) Organ Procurement and Transplantation Network (OPTN).

Results:  A total of 2844 recipients of LDLT were identified. Of these, 2690 (94.6%) underwent RL-LDLT and 154 (5.4%) underwent LL-LDLT. A recent increase in the number of LL-LDLTs was noted: average numbers of LL-LDLTs per year were 5.2 during 1998–2003 and 19.4 during 2004–2010. Compared with RL-LDLT recipients, LL-LDLT recipients were younger (mean age: 50.5 years vs. 47.0 years), had a lower body mass index (BMI) (mean BMI: 24.5 kg/m2 vs. 26.8 kg/m2), and were more likely to be female (64.6% vs. 41.9%). Donors in LL-LDLT had a higher BMI (mean BMI: 29.4 kg/m2 vs. 26.5 kg/m2) and were less likely to be female (30.9% vs. 48.1%). Recipients of LL-LDLT had a longer mean length of stay (24.9 days vs. 18.2 days) and higher retransplantation rates (20.3% vs. 10.9%). Allograft survival in LL-LDLT was significantly lower than in RL-LDLT and there was a trend towards inferior patient survival. In Cox regression analysis, LL-LDLT was found to be associated with an increased risk for allograft failure [hazard ratio (HR): 2.39)] and inferior patient survival (HR: 1.86).

Conclusions:  The number of LL-LDLTs has increased in recent years.

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