Living donor liver transplants may drastically decrease mortality from liver failure

Sep 04, 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, a journal by John Wiley & Sons. The recent experience of U.S. patients shows that recipient mortality rates and donor morbidity rates are acceptable.

Acute liver failure occurs more than 2,000 times per year in the United States and can quickly lead to coma and death. While spontaneous recovery can occur, for many patients the only effective therapy is liver transplantation. One-year survival for these transplant recipients is about 82 percent (just slightly less than for other indications) however, because of the shortage of donor livers, many patients with ALF die on the waiting list.

While other countries frequently use living donor liver transplantation 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 U.S. because it includes data from a large cohort of LDLT candidates at 9 U.S. transplant centers.

Researchers, led by James F. Trotter of the University of Colorado, report the outcomes of recipients with acute liver failure and their donors from the A2ALL study. It includes information from 1201 potential LDLT patients from January 1998 and April 2007. Just 14 (1 percent) of the patients had acute liver failure. Ten of these received LDLT, three received a liver from a deceased donor (DDLT), and 1 improved enough to be removed from the waiting list.

Survival rates were 70 percent after LDLT, compared to 67 percent of DDLT. Over a median of five years follow-up post-transplant, the nine surviving patients experienced 39 complications, a rate similar to other patients who'd undergone LDLT in the A2ALL study. Furthermore, the risks to the donors were acceptable—none died, while 50 percent experienced complications.

"This study demonstrates that LDLT may be performed safely in patients with ALF," the authors report. While the data was limited, and the patients may have been predicted to have more favorable outcomes than 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."

An accompanying editorial by Chung Mau Lo of the University of Hong Kong, 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 writes.

"The concerns with the added donor risk and inferior recipient outcome which have led to the proscription of acute liver failure as an indication for LDLT in the New York Department of Health's guidelines were not borne out in the A2ALL study," Lo points out. Still, he suggests LDLT will continue to take a limited role in the United States, despite the potential for optimally timed liver transplant for patients with ALF.

Source: Wiley

Explore further: West Africa's Ebola outbreak has claimed 137 lives

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

Researchers discover target for treating dengue fever

13 hours ago

Two recent papers by a University of Colorado School of Medicine researcher and colleagues may help scientists develop treatments or vaccines for Dengue fever, West Nile virus, Yellow fever, Japanese encephalitis and other ...

Tracking flu levels with Wikipedia

13 hours ago

Can monitoring Wikipedia hits show how many people have the flu? Researchers at Boston Children's Hospital, USA, have developed a method of estimating levels of influenza-like illness in the American population by analysing ...

User comments : 0

More news stories

Leeches help save woman's ear after pit bull mauling

(HealthDay)—A pit bull attack in July 2013 left a 19-year-old woman with her left ear ripped from her head, leaving an open wound. After preserving the ear, the surgical team started with a reconnection ...

Scientists tether lionfish to Cayman reefs

Research done by U.S. scientists in the Cayman Islands suggests that native predators can be trained to gobble up invasive lionfish that colonize regional reefs and voraciously prey on juvenile marine creatures.

Better thermal-imaging lens from waste sulfur

Sulfur left over from refining fossil fuels can be transformed into cheap, lightweight, plastic lenses for infrared devices, including night-vision goggles, a University of Arizona-led international team ...

Hackathon team's GoogolPlex gives Siri extra powers

(Phys.org) —Four freshmen at the University of Pennsylvania have taken Apple's personal assistant Siri to behave as a graduate-level executive assistant which, when asked, is capable of adjusting the temperature ...