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Title: Living Donor Liver Transplants May Drastically Decrease Mortality From Liver Failure in US
URL: http://www.pslgroup.com/dg/22AF7E.htm
Doctor's Guide
September 5, 2008

HOBOKEN, NJ -- September 5, 2008 -- Patients with acute liver failure (ALF) could be saved by a transplant from a living donor (LDLT), according to a new study in the September issue of Liver Transplantation.

The recent experience of US patients shows that recipient mortality rates and donor morbidity rates are acceptable.

While other countries frequently use LDLT for ALF patients, the treatment is rarely considered in the United States because of concerns about high post-operative mortality rates, risks to the donors, and whether donors can be appropriately evaluated during the rapid progression of ALF.

The Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) provides a chance to study LDLT for ALF in the United States because it includes data from a large cohort of LDLT candidates at 9 US transplant centres.

James F. Trotter, MD, University of Colorado, Boulder, Colorado, and colleagues report the outcomes of recipients with acute liver failure and their donors from the A2ALL study.

The study included data on 1,201 potential LDLT patients from January 1998 to April 2007. Only 14 (1%) of the patients had acute liver failure. Of these, 10 received LDLT, 3 received a liver from a deceased donor (DDLT), and 1 improved enough to be removed from the waiting list.

Survival rates were 70% after LDLT, compared with 67% of DDLT. Over a median of 5 years follow-up post-transplant, the 9 surviving patients experienced 39 complications -- a rate similar to other patients who underwent LDLT in the A2ALL study. Furthermore, the risks to the donors were acceptable. None of the donors died and 50% experienced complications.

"This study demonstrates that LDLT may be performed safely in patients with ALF," the authors wrote.

While the data were limited and the patients may have been predicted to have more favourable outcomes compared with typical ALF patients, the findings are similar to the global experience with LDLT for ALF.

"In summary, these preliminary findings suggest that LDLT is a safe treatment option in selected patients with ALF," the authors conclude. "These results provide a rational basis for the continued, careful application of LDLT in patients with ALF."

In an accompanying editorial by Chung Mau Lo, MD, University of Hong Kong, Hong Kong, China, commends the authors for evaluating the role of LDLT for ALF in the United States. "The most striking finding was the rarity for patients with acute liver failure to be considered for LDLT in the United States," he said.


SOURCE: Wiley-Blackwell

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