In summary, this meta-analysis and meta-regression confirms that LDLT provides superior overall patient survival when compared to DDLT, regardless of region of practice, spanning patients from both the East and the West. LDLT recipients are usually transplanted with a lower MELD, spend less time on the waiting list, have a lower risk of rejection, and have a comparable risk of post–operative vascular complications and infections with an equivalent length of stay when compared to DDLT. LDLT is associated with a higher rate of biliary complications, but this does not impact overall survival.
Recently, there has been renewed interest and growth in LDLT in the U.S. However, the overall proportion continues to be well below 10% of all adult LT, and only 20 states had LDLT activity in 2019. As the proportion of financially vulnerable LT candidates continues to grow, a greater proportion of patients will be covered by public health insurance, which can further limit ability to travel to an out-of-state LDLT center. This meta-analysis supports the continued expansion of LDLT for patients with end-stage liver disease who have access to a suitable living donor, even in regions where DDLT predominates, as LDLT allows for transplant at a lower MELD score, in patients with less deteriorated health condition, and can optimize posttransplant outcomes.
A2ALL, Adult-to-Adult Living Donor Liver Transplantation Study; CI, confidence interval; DDLT, deceased donor liver transplantation; HAT, hepatic artery thrombosis; HCC, hepatocellular carcinoma; HR, hazard ratio; LDLT, living donor liver transplantation; MD, mean difference; MELD, Model for End-Stage Liver Disease; OR, odds ratio; SRTR, Scientific Registry of Transplant Recipients.
No financial support was received for this study.
American Journal of Transplantation. 2021;21(7):2399-2412. © 2021 Blackwell Publishing